University  of  California  •  Berkeley 


I 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 


\> 


PRESENTED  BY 

'PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 

C8 
1793 


JgOM 


FIRST     LINES 

OF    THE 

PRACTICE  r-  PHY  SIC. 

B  Y 

WILLIAM  CUL      ;N,   M.  D. 

LATE    PROFESSOR    OF    THE    PRACTICE    OF    PHYSIC    IN    TH£ 
UNIVERSITY    OF    EDINBURGH,    &C.   &C. 


IN    TWO    V  O  L  U  M  E  S. 


WITH  PRACTICAL  AND  EXPLANATORY  NOTES, 

B   Y 

JOHN    ROTH  ERA  M,       M.  D. 
TO  WHICH    IS    PREFIXED 

THE    LIFE    OF    THE    AUTHOR. 


VOL.     II. 


N  E  W-  Y  ORE: 

BT  SAMUEL   CAMPBELL,  BOOK-SELLER  AND 
No.  37,  HANOVER-SQJJARK. 


CONTENTS 

OF      THE 

SECOND    VOLUME, 


PARTI.       B  O  O  K    IV. 

CHAP.         VI. 

Page 

Of  the  Menorrhagia,    or  the  immoderate  flow  of 
the  Menfes 

CHAP.         VII. 
Of  the  Leucorrhcea,  Fluor  Albtts,  or  Whites  19 

CHAP.         VIII. 
Of  the  Amenorrhcea,  or  Interruption  of  the  Menfes  21 

C     H     A     P.         IX. 

Of  Symptomatic  Hemorrhages  30 

Sedl.  I.   Of  the  Hematemajis,  or  Vomiting  of 

Blood  '  ibid 

Seel.  II.  Of  the  Hematuria,  or  the  'voiding  of 

Blood  from  the  Urinary  Pafjage  39 

BOOK'     v. 

Of  Projluvia,  or  Fluxes,  with  Pyrexia  46 

CHAP.         I. 
Of  the  Catarrh  47 

CHAP.         II. 
Of  the  Dyfentery  c6 

PART        II. 
Of  NeurofeSy  or  Nervous  Difeafes  65 

BOOK          I. 
Of  Comate)  or,  of  the  lofs  of  Voluntary  Motion         67 

CHAP.         I. 
Of  Apoplexy  ibid 

C     H     A     P. 


k  CONTENTS. 

CHAP.         IL 

Of  Palfy  Page  S8 

BOOK        II. 

Of  Adynamia  i  or  Difeafes  corifaftinq  in  a  weaknefs, 

or  lofs  of  Motion  in  either  the  'vital  or  natural 
Functions  101 

CHAP.        I. 
Of  Syncope-^  or  Fainting  ibid 

C     H     A     P.         II. 
Of  Dyfpefi/ia,  or  Indigeftion  no 

CHAP.         III. 

Of  Hypochondria/is^  or  tie  Hypochondriac  Affec- 
tion ,  commonly  called  Vapours  or  Low  Spirits       126 

BOOK        III. 

Of  Spafmodic  Affections  without  Fever  136 

Sect.  I.  Of  the  Spafmodic  Affections  of  the  ani- 
mal Functions  137 

CHAR        I. 
'Of  Tetanus  1^9 

C     H     A     P.         IL 
Of  EpUepfy  153 

CHAP.        III. 

Of the  Chorea^  or  Dance  of  St.  Fit  us  178 

Sea.  II.   Of  the  Spafmodic  Affections  of  the  Vi- 
tal Functions  182 

CHAP.        IV. 
Oftbs  Palpitation  of  the  Heart  ibul 

C     H     A    P.         V. 
Of  Dyfpncea,  or  difficult  Breathing  185 

CHAP.         VI. 
Of  AJlhma  187 

CHAP.        VII. 

he  Cbincougv,  or  Hooping  Cough  198 

Sect.  III.   Oftbt  Spafmsdic  Ajfcaions  in  the 

:\-;s  209 

C     H     A     P. 


C    O    N    T    E    N    T 

C     H     A     P.         VIII. 

Of  the  Pyrqfis,  or  what  is  named  in  Scotland 

the   Water-brajh  Page  20 

CHAP.         IX. 
Of  the  Colic  212 

CHAR      -  X. 
Of  the  Cholera  -222 

CHAP.         XL 
Of  Diarrhoea^    or  Loofenefs  227 

CHAP.         XII. 
Of  the  Diabetes  243 

CHAP.         XIII. 
Of  the  Hyfteria^  or  the  Hyfteric  Difeafe  247 

CHAP.        XIV. 
Of  Canine  Madnefs  and  Hydrophobia  254 

BOOK         IV. 

Of  Vefania^  or  of  the  Dif orders  of  the  Intelkftual 
Functions  256 

CHAP.         I. 
Of  Vefaniae  in  general  Ibid 

CHAP.         II. 
Of  Mania ,  or  Madnefs  270 

C     H     A     P.          III. 
Of  Melancholy,  and  other  forms  of  Infant 'ty  281 

PART        III. 
Of  Cachexies  290 

BOOK        I. 
Of  Emaciations  291 

BOOK         II. 
Of  Intumefcentia^  or  General  Swellings  303 

CHAP.         I. 
Of  Adipofe  Swellings  304 

CHAP.         II. 
Of  Flatulent  Swellings  308 

CHAP.        Ill, 
Of  Watery  Swellings,  or  Dropfies  3 1 8 


yi  CONTENTS, 

Seft.  I.  Of  Anafsrca  Page  333 

Se<5t.  II.   O/*  the  Hy.drotb.orax,  or  Dropfy  of 

the  Breaft  344 

Seft.  III.  Of  the  Afcltcs,  or.  Dropfy  of  th? 

Lower  Belly  350 

CHAP.        IV. 
Of  General  Swellings,  arifing  from  an  increased 

bulk  of  the  whole  fubftance  of  particular  $  arts       355 
Of  Rachitis,  or  Rickets  ibid 

BOOK        1IL 

Of  the  Impetignisi  or  depraved  habit,  with  of- 
feftions  of  the  Skin  367 

C     H     A     P.         I. 
Of  Scrophula,  or  the  King's  Evil  368 

CHAP.         II. 
Of  SipbyHs)  or  the  Venereal  Difeafe  378 

CHAP.        III. 
Of  Scurvy  394 

C     H     A     P.         IV. 
Of  Jaundice  404, 


FIRST 


FIRST      LINES 

OF   THE 

PRACTICE    OF   PHYSIC. 

PART    I.      BOOK    IV. 


CHAP.       VI. 

-* 

OF  THE  MENORRHAGIA, 

OR    THE 

IMMODERATE  FLOW  OF  THE  MENSES. 

DGCCCLXVI. 

BLOOD  difcharged  from  the  vagina  may  proceed 
from  different  fources  in  the  internal  parts  :  but 
I  here  mean,  to  treat  of  thofe  difcharges  only,  in  which 
the  blood  may  be  prefumed  to  flow  from  the  iame 
fources  that  the  menfes  in  their  natural  Hate  proceed 
from  ;  and  which  difcharges  alone,  are  thofe  proper- 
ly comprehended  under  the  prefent  title.  The  title 
.of  Metrorrhagia,  or  haemorrhagla  uteri^  might  compre- 
hend a  great  deal  more. 

DCCCCLXVII. 

The  menorrhagia  may  be  confidered  as  of  two  kinds ; 
VOL,  II.  B  either 


io  PRACTICE 

either  as  it  happens  to  pregnant  and  lying-in 
or  as  it  jjappens  to  women  neither  pregnant  nor  hav- 
ing recently  born  children.     The  Sift  kind,  as   con- 
nected with  the  circ\imi£ances  of  pregnancy  and  child-' 
bearing,  (which  are  not  to  .jf  in  the  prefenc 

courfe)  I  am  not  to  contlder  here,    but  ihall  confine 
znyfelf  to  theiecond  kind  of  menorrhagia  only. 
DCC..CCLXVIH. 

The  flow  of  the  me'nfes  is  coniidered  as  immoderate, 
when  it  recurs  more  frequently*,  when  it  continues 
longer,  or  when,  during  the  ordinary  continuance  §, 
it  is  more  abundant  -[•  than  is  ufiial  with  the  fame  per- 
fon  at  other  times, 

DCCCCLXIX. 

As  the  mod  part  of  women  are  liable. to  fonie  ine- 
quality with  rcfpect  to  the  period,  the  duration,  and 
the  quantity  of  their  menfes ;  fo  it  is  not  every  ine- 
quality in  thefe  refpeclis  that  is  to  be  ccaiidercd  as  a 
difeafe ;  but  only  thofe  deviations^,  which  ar^lxcei-.. 
live  in  degree,  which  are  permanent,  and  which  in- 
duce a  manifefi  ftate  of  debility. 
DCCCCLXX. 

The  circumftances  (DCCCCLXVUI.  Dcccajpjix.) 
are  thofe  which  chiefly  conititute  the  menorniagia •: 
but  it  is  proper  to  obferve,  that  although  I  allow  the 
frequency,  duration,  and  quantity  of  the  menfes  to  be 
judged  of  by  what  is  ufual  with  the  *;>;v-e  individual  at 
other  times ;  yet  there  is,  in  thefe  particulars,  fo  much 

in  the  w  lex,  that  in 

any 

*  The  ufual  period  rs  from  T::ys. 

§  The  time  o£  it'fl  nt  people; 

it  fcldom  continues  l'>n^v;'  ih  or  fliprter  than  two. — 

In  general,  \vo:'u:ti  »>!  a  lax  and  >n  have  a 

.     ' 

copious  and  a  i«  • 

-J-    It  is  i  :~-;;rtain   precsKiy  \vh  i-yis 

ufually  discharged  ;   but    the    women   themfe'ves   can    generally    in- 
:he  phyiiciau  with  fufficicnt  cx-.idtnefs  for  ri-^ulatiug  thcpi.vj- 
.  ht'thcr  the  Jilcharge  be  fcnmodcratc* 


OF    i5  H  Y  S  I  C.  is 

- 

individual  in  whom  there  occurs  any  confiderable 
deviation  from  the  common  meafure,  fuch  a  deviation 
af  conftantly  recurring,  may  be  ccnfidered  as  at  leaft 
approaching  to  a  morbid  ftate,  and  as  requiring  molt 
of  the  precautions  which  I  mail  hereafter  mention  as! 
neceiTary  to  be  attended  to  by  thofe  who  are  actually  iii 
fuch  a  ft  ate. 

DCCCCLXXI. 

However  we  may  determine  with  refpect  to  the  cir- 
cumftances  DCCCCLXVIII.  DCCCCI.XIX.  it  mull  Hill  be 
f:i lowed,  that jfche  iVa model  are  flow  of  the  menfes  is 
efpecialiy  to  ^•fcrmhied  by  thofc  fy  in  p  Corns  afiect- 
ing  other  function's  of  the  body,  which  accompany  and 
follow  the  di (charge. 

When  a  larger  flow  than  ufual  of  the  menfes  has  i 
been  precgde^bv  headach,  giddinefs,  or  difpncea,  and 
has  be^ft  -  in   fci*yi  cold  ftage,  and    is  attended 

with.muo^Hm  of  theoack  and  loins,  with  a  frequent 
pulfe,  i.  I  d  thirft,  it  may  then  be  confidercd  as 
preternaturally  large. 

DCCCCLXXIL 

TVhen,  in  confequcnce  of  the  circumftances  DCCCC- 
LXVIII. — DCCCCLXXI.  and  the  repetition  of  thefe,  the  ; 
f^ice   becomes  pale;  the  pulfe  g-  ;:;,k:  an  unufti-  | 

al  tietitoty  is  felt  in  excrciib  ;  the  breathing  is  hurried  i 
by  n,  •  cxsrcife:  \vhen5   aifo,   the  b  ck  becrmcs 

pained  From   any   continuance   in   an  erect  pofture  ; 
when  the  extremities  become  frequently  cold;  and  ! 
when  in  the  evening  the  feet  appear  to  be  affected  with 
cedemntous  fweiling;  we    may  from   tbrfe  fymp: 
certainly  conclude,  that  the  flow  of  the  mehfes  has 
;>ecn  1^1:10 derate,  and  has  already  induced  a  danger-   i 
culflate  of  debility  • 

DCCCCLXXIII. 

The  debility  thus  induced  does  often  difcover  irfelf 
y  affections  cf  the  ftomach,  as  anorexia  and  other 
B  2 


12  PRACTICE 

fymptoms  of  difpepfia ;  by  a  palpitation  of  the  heart, 
and  frequent  faintings;  by  a  weaknefs  of  mind  liable 
to  ftrong  emotions  from  flight  caufes,  efpecially  when 
fuddenly  prefented. 

DCCCCLXXIV. 

That  flow  of  the  menfes,  which  is  attended  with 
barrennefs  in  married  women,  may  be  generally  con- 
lidered  as  immoderate  and  morbid. 
DCCCCLXXV. 

Generally,  alfo,  that  flow  of  the  menfes  may  be  con- 
fidered  as  immoderate,  which  is  preceded  and  follow- 
ed by  a  leucorrhcea. 

DCCCCLXXVr. 

I  treat  of  menorrhagia  here  as  an  active  hemorrhagy, 
becaufe  I  conilder  menftruation,  in  its  natural  ftate,  to 
be  always  of  that  kind  ;  and  although  there  fhould  be 
cafes  of  menorrhagia  which  might  be  confidered  as 
.purely  paffive,  it  appears  to  me  that  they  cannot  be  fo 
properly  treated  of  in  any  other  place. 

DCCCCLXXVII. 

The  menorrhagia  (DCCCCLXXVIU,  et  feq.*)  has  for 
its  proximate  caufe,  either  the  hemorrhagic  effort  of 
the  uterine  veffeis  preternaturally  increafed,  or  a  pre- 
ternatural laxity  of  the  extremities  of  the  uterine  ar- 
teries, the  hemorrhagic  effort  remaining  as  in  the  na- 
tural ftate. 

DCCCCLXXVHI. 

The  remote  caufes  of  the  hemorrhagia  may  be,  ift, 
Thofe  which  increafe  the  plethoric  ftafe  of  the  uterine 
veflels ;  fuch  as  a  full  and  nouriming  diet,  much  ftrong 
liquor,  and  frequent  intoxication,  idly,  Thofe  which 
determine  the  blood  more  copioufly  and  forcibly  into 
the  uterine  veflels  ;  as  violent  {trainings  of  the  whole 
body  ;  violent  (hocks  of  the  whole  body  from  falls  ; 
violent  ftrokes  or  contufions  on  the  lower  belly  ;  vio- 
lent exercifc,  particularly  in  dancing  ;  and  violent  paf- 
fions  of  the  mind.  3^,  Thqfe  which  particularly  ir- 


O  F    P  H  Y  S  I  C.  13  i 

ritatc  the  vefiels  of  the  uterus  ;  as  excefs  in  venery ; 
the  exercife  of  venery  in  the  time  of  menflruation  ;  a 
coitive  habit,  giving  occaiion  to  violent  {training  at 
ftool  ;  and  cold  applied  to  the  feet1*.  4th ly,  Thofe 
which  have  forcibly  overft rained  the  extremities  of 
the  uterine  veflels  ;  as  frequent  abortions ;  frequent 
child-bearing  without  nurfingf  ;  and  difficult  tedious 
labours,  Or,  lajtly,  Thofe  which  induce  a  general  lax- 
ity ;  as  living  much  in  warm  chambers,  and  drinking 
much  of  warm  enervating  liquors,  fuch  as  tea  and 
coffee. 

DCCCCLXXIX. 

The  effects  of  the  menorrhagia  are  pointed  out  in 
DCCCCLXXH — DccccLxxm.  where  I  have  mentioned 
the  feveral  fymptoms  accompanying  the  difeafe  ;  and 
from  thefe  the  confequences  to  be  apprehended  will 
alfo  readily  appear. 

DCCCCLXXX, 

The  treatment  and  cure  of  the  menorrhagia  muft 

be 

*  It  is  difficult  to  account  for  the  catife  of  menorrhagia  ;  it  may 
perhaps  be  owing  to  the  circulation  through  the  lower  extremities 
being  obftrufted  or  impeded,  and  confeqirently  a  greater  How  of 
blood  to  the  uterus.  The  fa6l,  however,  is  certain  ;  for  experience 
fufficiently  evinces  that  menorrhagia  frequently  follows  'in  imprudent 
cxptfure  of  the  feet  to  cold,  efpecially  damp  cold.  Sitting  in  wet 
fiioes,  or  in  a  damp  cold  room  with  a  Hone  floor,  ought  to  be  care- 
fully avoided  by  ladies  of  a  delicate  conilitution. 

f  By  nurfing,  the  fluids  are  determined  to  the  bre.afl>  and  in  a 
peculiar  manner  derived  from  the  uterus.  This  part  of  the  cecono- 
my  of  nature  phyfiologifts  have  not  yes:  fufncieutly  explained,  but 
the  fa 61  is  weli  ascertained.  Nurfing  is  not  only  ufcful  in  preventing 
nienorrliagia,  but  as  it  derives  the  fluid  ; -us,  it  prevents 

alfo  frequent  child-bearing  ;  and  conic;  atcil 

advantage  of  all  others,  time  is  allowed  to  the  uterus  for  regaining  it's 
former  tone  and  ftrength  :  The  fubfequent  child-births  are  aif  • 
dercu  more  eafy  than  they   would  ether  wife  be,    and   the    ch'- 
more  healthy.       It  would  be  improper  to  enumerate:  Ivan- , 

tagcs  of  nurfing  in  this^ace,   as  I  fhall  refervc  tiic  ex- 
them  for  a  future  publication. 


I  i4  PRACTICE 

be  different,   according  to  the  different  caufes  of  th$ 
difeafe. 

In  all  cafes,  the  firft  attention  ought  to  be  given  to 
avoiding  the  remote  caufes,  whenever  that  can  be 
done  ;  and  by  that  means  the  difeafe  may  be  often  en- 
tirely avoided. 

When  the  remote  caufes  cannot  be  avoided,  or  when 
the  avoiding  them  has  been  neglected,  and  therefore 
a  copious  rnenftruation  has  come  on,  it  iliould  be  mo- 
ted  as  much  as  pofiible,  by  abftaining  from  all  e2c- 
fe,  'either  at  the  coming  on,  or  during  the  conti, 
nuance  of  the  menftruation  ;  by  avoiding  even  an 
creel  pofture  vis  much  as  poffible  ;  by  fliunning  exter- 
nal heat,  and  therefore  warm  chambers  and  foft  beds ; 
by  ufing  a  light  and  cool  diet ;  by  taking  cold  drink, 
at  lead  as  far  as  former  habits  will  allow  :  by  avoiding 
venery  ;  by  obviating  coftivenefs,  or  removing  it  by 
laxatives  that  give  little 'ftirrmlus*. 

The  fcx  are  commonly  negligent,  either  inavojding 
the  remote'caufes,  or  in  moderating  the  firft  beginnings 
of  this  difeafe.  It  is  by  fuch  neglect  that  it  fo  frequent" 
ly  becomes  ,  and  of  difficult  cure ;  and  the  fre- 

:t  repetition  of  a  copious  menftruation.  may  be 
mnfidered.  ns  n.  cnufe  of  great  laxity  in  the  extreme  vef- 
fcls  of  the  uterus. 

DGCCCLXXXI. 

*    ',"     "         "•      ;":-Ht  give  little  {Itmulus  arc  manna,  oil,  tamarinds, 
•  mi'I-.l  iubllanr.es.      Aloetic  and  other  ciraftic  purges, 
muft  be  carefiillf  avoided.      Rhubarb,    in    moderate  dotes t  is  only 
acimifTibls  in  cafes  where  there  is  an  evident  atony  of  the  ftomacfa   or 
rnr!  in  tlvfe  cafes  it  ought  to  be  given  in  fubitance,   or  in 
'•ifufjon.      The  fpirituous  and  vinous  tinctures  of  it    arc 
ahfol  in   menorrhagia.      A    table- fpo'onful  of  the 

;=?,  taken  occafionally,  will  fulTiciently   obvj     ;  cofr 
tlvencfv,  without  giving  much  llimulas  : 
^>  Man.  opt.  ^ii. 
Ol.  ricini  ^i. 
Svr.  rofar.  Joint.  |i. 
n.  tartar.   5fs, 


O  F    P  H  Y  S  1  a  15 

DCCCCLXXXI. 

When  the  coming  on  of  the  menftruiition  has  been 
preceded  by. feme  diforder  in  other  parts  of  the  body 
and  is  accompanied  wit;h  pains  of  the  back,  Tefembling 
parturient  pains,  together  with  febrile  fymptoms, 
when  at  the  fame  time  the  flow  Teems 'to  be  copious, 
then  a  bleeding  at  the  arm  may  be  proper,  but  it  is 
not  often  rtecefiary  ;  and  it  will  in  rnoft  cafes  be  fufft- 
cient  to  employ,  with  great  attention  and  diligence, 
thofe  means  for  moderating  the  difcharge  which  have 
been  mentioned  in  the  iaft  paragraph. 
DCCCCXXXII, 

When  the  immoderate  flow  of  the  menfes  {hall  feem 
to  be  owing  to  a  laxity  of  the  veffels  of  the  uterus,  as 
may  be  concluded  from  the  general  debility  and  laxity 
of  the  pe: Ton's  habit;  from  the  remote  caufes  that  have 
occafioned  the  difeafe  (DCCCCLXXVIII. )  from  the  ab- 
fence  of  the  fymptoms  which  denote  increafed  action 
in  the  vefTels  of  the  uterus  (DCCCCLXXI.)  from  the  fre- 
quent recurrence  of  the  dife.de  ;  and  particularly  from 
this,  that  in  the  intervals  of  menflruation  the  perfon 
is  liable  to  a  leucorrhcea  ;  then  in  fiich  cafe  the  difeafe 
is  to  be  treated,  not  only  by  employing  all  the  means 
mentioned  in  DCCCCLXXX.  for  moderating  the  heraor- 
rhagy,  but  alfo  by  avoiding  all  irritation,  every  irrita- 
tion having  the  greater  effect  in  proportion  as  the  vef- 
fels  have  been  more  lax  and  yielding.  If,  in  fuch  a 
cafe  of  laxity,  it;  ihali  appear  that  forn  up  'of  irri- 

tation concurs,  opiates  may  be  employed  to  moderate 
the  difcharge  ;  but  in  ufmg  thefe,  much  caution  i 
quifite*. 

If,  not  with  (landing  thefc  me^fares  having  been  ta- 
ken, the  difcharge  {hall  prove  very  large,  aitdngentsf , 

both 

*   Opiates  ufed  too  liberally,  generally  increafe  the  difchavg- 
;:e  of  their  very  great  power  in  relaxing  the  wlu 

f  >ents  fur  internal  ufe  are,  alum,  catechu    tinch: 

vofes,  &c.     Tea  v-ia'ns  of  alum,  and  as  much  catechu  may  be  given 
i'.i   powder,  every  f.vo  or  three  hours,   with  three* or  four  fpoonfuls 


16  PRACTICi; 

"both  external  and  internal,  may  be  employed.     In 

fuch  cafes,  may  fmall  dofes  of  emeticesbe  of  fervice  ? 

DCCCCLXXXIII. 

When  the  menorrhagia  depends  on  the  laxity  of  the 
uterine  veffels,  it  will  be  proper,  in  the  intervals  of 
menilruation,  to  employ  tonic  remedies  ;  as  cold  bath- 
ing and  chalybeates*.  The  exercifes  of  geftation,  al- 
fo,  maybe  very  ufcfal,both  forurengtbening  the  whole 
fyftem,  and  for  taking  off  the  determination  of  the 
blood  to  the  internal  parts. 

DCCCCLXXXIV. 

The  remedies  mentioned  in  thefe  twolafl  paragraphs, 
may  be  employed  in  all  cafes  of  menorrhagia,  from 
whatever  caufe  it  may  have  proceeded,  if  the  difeafe 
ihall  h.ive  already  induced  a  conliderable  degree  of 
debility  in  the  body.  *  . 

CHAP. 

of  tincture  of  rofes  to  wafh  it  down.     The  bark  is  fometimcsof  ufc 
in  thefe  cafes,  cfpecially  when  joined  with  alum.      The  external  ap- 
plications are,  cold  clothes  foaked  in   vinegar  and  water  applied  to 
the  lower    region   of  the  abdomen,   or  to  the  pudenda  ;  or  a  ftrong 
decoclion  of  oak-bark,  with  an  ounce  of  alum  diflbived  in  every  pint 
of  it,  may  be  applied  cold  to  the  fame  parts. 
k   The  following  form  is  very  convenient. 
J$>,  Rubigin.  ferri.  311, 

Corr.  Peruv.  §u 

Syr.  Simpl,  q.  f. 

M.  f.  Elea. 

The  dofe  of  this  eledluary  is  to  be  varied  according  to  the  conflitu- 
tion  ;  the  fize  of  a  nutmeg  twice  a  day  is  ufually  given. 

The  bed  forms  of  chalybeates,  in  thefe  cafes,  are  the  mineral  wa- 
ters which  contain  iron  diffolved  by  fixed  air.  Chalybeate  waters 
mould  not,  in  this  difeafe,  be  drank  in  fuch  large  quantities  as  to 
pafs  off  by  {tool.  A  jill  taken  every  three  or  four  hours  throughout 
the  day,  with  a  fpoonful  of  port  wine,  is  more  efficacious  than  a 
pint,  ur  even  a  quart,  taken  at  once  in  the  morning.  The  dofe, 
however,  of  thefe  waters,  varies  according  to  the  ftrength  of  the 
particular  water  we  ufe.  Along  with  the  chalybeate  water,  a  fcru- 
ple,  or  half  a  drachm  of  Peruvian  bark  may  be  given  twice  a  day. — 
The  following  form  is  very  agreeable,  and  is  at  the  fame  time  fmgu- 
larly  efficacious : 


dFPHtSIC.  17 

CHAP.         VII. 

OF  THE  LEUCORRHCEA,  FLUOR  ALBUS,  OR 
WHITES.  ,     , 

DCCCCLXXXV. 

EVERY  ferous  or  puriform  difcharge  from  the  va- 
gina, may  be,  and  has  been,  comprehended  un- 
der one  or  other  of  the  appellations  I  have  prefixed 
to  this  chapter.  Such  discharges,  however,  may  be 
various ;  and  may  proceed  from  various  fources,  not 
yet  well  afcertained  :  but  I  confine  myfelf  here  to  treat 
of  that  difcharge  alone  which  may  be  prefumed  to 
proceed  from  the  fame  vefTcls,  which,  in  their  natural 
Itate,  pour  out  the  menfcs. 

DCCCCLXXXVI. 

I  conclude  a  difcharge  from  the  vagina  to  be  of  this 
kind*;  i.  From  its  happening  to  women  who  arefub- 
ject  to  an  immoderate  flow  of  the  menfes,  and  liable 
to  this  from  caufes  weakening  the  veflels  of  the  uterus, 
2.  From  its  appearing  chiefly,  and  often  only,  a  lit- 
tle before,  as  well  as  immediately  after,  the  flow  of  the 
menfes.  3.  From  the  flow  of  the  menfes  being  di- 
mini fried,  in  proportion  as  the  Icucorrhoea  is  increafed* 
4.  From  the  leucorrhcea  continuing  after  the  menfes 
have  entirely  ceafed,and  with  fomc  appearance  of  its 
obferving  a  periodical  recurrence.  5.  From  the  leu- 

C  corrhcea 

£.  Extrad.  cort.  Perur.  §i. 
Extract.  Campechcnf. 
Extract.  Glychyrrh.  a  a  3jfs. 
Mucilag.  Gum,  Arab.  q.  f. 
M.  f.  Elea, 
The  dofc  is  half  a  drachra  or  two  fcruples  twice  a-day. 

*  The  young  pra&itioner  ought  to  pay  great  attention  to  the 
diagnoliics  of  the  leucorrhcea  delivered  in  this  article. 


i8  PRACTICE. 

corrhcea  being  accompained  with  the  effect  of  the 
menorrhagia  (DCCCCLXXII.  DCCCCLXXIH.)  6.  From 
the  difcharge  having  been  neither  preceded  by.  nor 
accorrpained  with,  fymptoms  of  any  topical  afFe&ions 
of  the  uterus.  7.  From  the  leuccrrhcea  not  having 
appeared  foon  after  communication  with  aperfon  who 
might  be  fufpecled  of  communicating  infection,  and 
from  the  full  appearance  of  the  diieaie  not  being  ac- 
companied with  any  inflammatory  auection  of  ihe  pu- 
denda*. 

DCCCCLXXXVII. 

The  appearance  of  the  matter  discharged  in  the 
leucorrbcea,  is  very  various  with  refpeclto  confidence 
and  colour ;  but  from  thefe  appearances  it  is  not  al- 
ways p-flible  to  determine  concerning  its  nature,  or 
the  particular  fourcefrom  whence  it  proceeds. 
DCCCCLXXXVIII. 

The  leucorrhcea,  of  which  I  am  to  treat,  as  afccr- 
tained  by  the  feveral  circumftances  DCCCCLXXXVI.  feems 
to  proceed  from  the  fame  caufes  as  that  fpecies  of  me- 
norrhagia which  I  fuppofe,  to  arife  from  the  laxity  of 
the  extreme  vefiels  of  the  uterus.  It  accordingly  of- 
ten follows,  or  accompanies  fuch  a  menorrhagia  ;  but 
though  the  leucorrhcea  depends  chic-fly  upon  the  laxi- 
ty mentioned 5  it  may  have  proceeded  from  irritations 

inducing 

*  Nothing  is  more  frequert  with  ignorant  practitioners  than  to 
mulakea  gonorrhoea  for  a  leucorrhcea.  Women  in  general  give  the 
name  of  whites  to  a  gonorrhoea,  and  therefore  the  unvvaiy  p> 
tioner  may  the  more  eafily  be  rmfled.  The  diftiaguiming  chare  clc- 
riftic  of  gonorrhoea  is,  as  the  author  fays,  an  inflammatory  affection. 
of  the  pudenda;  but,  as  few  women  will  fuffer  an  infpe&ion  of  the 
parts,  we  mull  pay  fome  attention  to  the  concomitant  fymptoms. 
The  running  in  a  gonorrhoea  is  condant,  and  only  in  fm:;!!  quanti- 
ties ;  in  a  leucorrhcea  the  difcharge  is  inconilant,  and  in  tarie 
Quantities.  The  other  diflinguifhing  marks  of  a  gonorrhoea 
fmarting  in  making  water,  itching  of  the  puderidi,  Jncreafed  incli- 
nation tor  vencry,  a  fwelling  of  the  lubia  and  of  the  glands  about 
the  groin.  Some  authors  mention  the  c  lour  of  the  dffchdt  ged  mat- 
ter as  a  diilinguilhing  mark  j  this,  however,  is  inconilant. 


O  F     P  II  Y  S  I  G.  19 

inducing  that  laxity,  and  feems  to  be  always  increafed 
by  any  irritations  applied  to  the  uterus. 
DCCCCLXXXIX. 

Some  authors  have  aliedged  that  a  variety  of  cir- 
cumftances  in  other  parts  of  the  body  may  have  a 
mare  in  bringing  on  and  in  continuing  this  atFection  of 
the  uterus  now  under  coniideration:  but  I  cannot  dif- 
cover  the  reality  of  thofe  caufes  ;  and  it  feems  to  me, 
that  this  leucoi  rhcea,  excepting  in  fo  far  as  it  depends 
upon  a  general  debility  of  the  iyllem,  is  always  prima- 
rily an  affection  of  the  uterus  ;  and  the  affections  of 
other  parts  of  the  body  which  may  happen  to  accom- 
pany it,  are  for  the  mod  part  to  be  confidcred  as  ef- 
fects, rather  than  as  caufes. 

DCCCCXC. 

The  effects  of  the  leiicorrhcea  are  much  the  fame 
with  thofe  of  meliorrhagia  ;  inducing  a  general  debi- 
lity, and,  in  particular,  a  debility  in  the  functions  of 
the  ftomach.  If,  however,  the  leticorrhcea  be  mode- 
rate, and  be  not  accompanied  with  any  confiderable 
degree  of  menorrhagia,  it  may  often  continue  long 
without  inducing  any  great  degree  of  debility,  and  it 
is  only  when  the  difeharge  has  been  very  copious  as 
well  as  conitantj  that  its  effects  in  thai  way  are  very 
remarkable. 

DCCCCXCI, 

But,  even  when  its  effects  upon  the  whole  body 
are  not  very  considerable,  it  may  ilill  be  f  applied  to 
weaken  the  genital  fyftem  ;  and  it  feems  fufficicntly 
probable  that  this  difcharge  may  often  have  a  fhare  in 
occafioning  baireniiefs. 

DCCCCXCII. 

The  matter  difcharged  in  the  leucorrhoea,  is  at  firll 
generally  mild  :  but  after  fome  continuance  of  the 
difeafe,  it  fometimes  becomes  acrid*  ;  and  by  irmat- 

G  2  .  ing 


The  young  pra&IKoner  muH:.  not  conclude  too  hadily  that  an. 


20  PRACTICE 

ing,  or  perhaps  eroding,  the  fur  faces  over   which  it 
paffes,  induces  various  painful  diforders. 
DCCCCXCIII. 

As  I  have  fuppofed  that  the  leucorrhcea  proceeds 
from  the  fame  caufes  as  that  fpecies  of  menorrhagia 
which  is  chiefly  owing  to  a  laxity  of  the  uterine  verTds, 
it  mult  be  treated,  and  the  cure  attempted,  by  the 
fame  meaus  as  delivered  in  DCCCCLXXXII  for  the  cure 
of  menorrhagia,  and  with  lefs  referve  in  refped  of  the 
ufe  of  aftringents*. 

DCCCCXCIV. 

As  the  leucorrhcea  generally  depends  upon  a  great 
lofs  of  tone  in  the  veifds  of  the  uterus,  the  difeafe  has 
been  relieved,  and  fometimes  cured  by  certain  ftimu- 
lant  medicines,  which  are  commonly  determined  to 
the  urinary  paffages,  and  from  the  vicinity  of  thefe  are 
often  communicated  to  the  uterus.  Such,  for  exam- 
ple, are  cantharides,  turpentine,  and  other  balfams  of 
a  fimilar  nature -jr. 

CHAP. 

ulcer  exids  in  the  uterus  when  the  matter  discharged  is  acrid. — ? 
Practice  has  offered  many  inftan-ces  where  the  matter  has  excoriated 
the  pudenda,  and  yet  no  ulcer  exifted* 

*  The  electuary  mentioned  at  the  end  of  the  laft  note  on  Article 
983,  has  been  found  very  efficacious  in  fome  cafes  of  leucorrhcea., — 
It's  dofe  may  be  increafed  to  a  drachm  thrice  a-day,  either  fwallovr- 
ed  as  a  bolus,  or  diffolved  in  an  ounce  of  pure  water,  and  half  an 
ounce  of  pure  cinnamon-water.  The  chalybeate  waters  are  ufed  in 
this,  as  well  in  the  former  difeafe  ;  and  they  may  be  ufed  in  the 
manner  above  mentioned.  Practitioners  recommend,  in  thefc 
cafes,  a  nutritive  but  not  a  heating  diet,  as  mucilaginous  broths 
made  with  rice,  cfpecially  veal-broth,  jellies  of  all  kinds,  except  thofe 
that  are  high  feafo-icd.  Port-wine  muft  be  prefcribed  in  a  mode- 
rate quantity,  according  to  the  habits  of  the  patient. 

•j*  The  prince  here  recommended  is  not  without  danger,  and 

muft  not  be.  followed  except  with  great  caution  and  circumspection. 

When  the  other  means  fail  in  producing  relief,  we  may  then  have 

recourfc  to  thefc  balfamics,  or  join  them  to  the  tonic  aftringents,  as, 

JJ>  Gum.  oliban. 

Terebinth,  venet.  t 


O  F    P  H  Y  S  I  C.  21 


CHAP.      VIII. 

OF   THE  AMENORRHCEA,  OR   INTERRUP- 
TION OF  THE  MENSTRUAL  FLUX, 

DCCCCXCV. 

WHATEVER,  in  a  fyftem  of  methodical  nofolo- 
gy,   may  be  the  fitteft  place  for  the  amenor- 
rhcea,  it  cannot  be  improper  to  treat  of  it  here  as  an 
object,  of  practice,  immediately  after  having  confider- 
ed  the  menorrhagia. 

DCCCCXCVI. 

The  interruption  of  the  menftrual  flux  is  to  be  con- 
fidered  as  of  two  different  kinds  ;  the  one  being  when 
the  menfes  do  not  begin  to  flow  at  that  period  of  life 
at  which  they  ufually  appear;  and  the  other  being 
that  when,  after  they  have  repeatedly  taken  place  for 
fonie  time,  they  do?  from  other  caufes  than  concep- 
tion, ceafe  to  return  at  their  ufual  periods  ;  The  form- 
er of  thefe  is  named  the  retention,  and  the  latter  the 
fi'fpreffion,  of  the  -menfes. 

DGCCCXCVII. 

As   the  flowing  of  the   menfes  depends  upon  the 

force 

Terra,  japonic,  a  a.  51. 

Sal,  martis  31*5. 

M.  f.  mafTa  in  pilulas  equales. 

No.  60.  dividend. 

Two  or  three  of  thefc  pills  may  be  given  twice  a-ctav  or  oftener* — 
Some  praclitioneis  have  ilrongly  recommended  the  following  emul- 
fion  : 

E»    Balfam.  copaivi.   ^i. 

Vitel.  ovi  No.  t. 

Tere  in  mortar,  marmor.  et  adde  gradatim. 

Aq.  font.  §vii. 

Svr.  Simpl.   ^i« 

M.  f.-'Emulf. 

The  dofe  of  this  emuHiQii  is  two  or  three  fpocnfuls  three  oribur 
times  a-day.  *" 


22  PRACTICE 

force  of  the  uterine  arteries  impelling  the  blood  into 
their  extremities,  and  opening  tbete  ib  as  to  pour  out 
red  blood  ;  fo  the  interrupuon  of  the  menftrtml  flux 
rauPc  depend  either  upon  the  want  of  due  force  in  the 
action  of  the  uteiine  arteries,  or  upon  fome  preternatu- 
ral refinance  in  their  extremities.  The  former  Imp- 
pole  to  be  the,  moil  ufiiul  cauiV  of  retention,  the  latrer 
the  mod  common  caufe  offupprelTion  ;  and  of  each  of 
thtfe  I  lliall  now  treat  more  particularly. 
DCCCCXCVIII. 

The  retention  of  the  menfes,  the  emanfio  menfium 
of  Latin  writers,  is  not  to  be  coniidered  as  a  dii'eaie 
merely  from  the  menfes  not  flowing  at  that  period 
uhich  is  ufual  with  moft  other  women.  This  period 
is  fo  different  in  diffeient  women,  that  no  time  can  be 
precifoly  alligncd  as  proper  to  the  lex  in  general. — 
In  this  climate,  the  menfes  ufually  appear  about  the 
of  fourteen  :  but  in  many  they  appear  more  early, 
and  in  many  not  till  the  fifteenth  year  :  in  which  laft 
caf~  it  is  often  without  any  diforder  being  thereby  oc- 
cafioned.  It  is  not  therefore  from  the  age  of  the 
perfon  that  the  retention  is  to  be  coniidered  as  a  dif- 
eaft ;;  and  it  is  only  to  be  considered  as  fuch,  when 
cb-jutthe  time  the  menfes  ufually  appear,  fome  difor- 
,  arife  in  other  parts  of  the  body  which  may  be  im- 
puted to  their  retention;  being  fuch  as,  when  arifmg 
at  this  period,  are  known  from  experience  to  be  re- 
moved by  the  flowing  of  the  menfes. 
DCCCCXCIX. 

Thefe    diforders  are,    a  fluggiihnefs,   and  frequent 
fenfe  of  latitude  and  debility,  with  various  fymptoins, 
of  dyfpepfici ;  and  fome  times  with  a  preternatural  ap- 
petite*.      At  the  fame  time  the  face  lofes  its  vivid  co- 
lour, 

*  This  is  a  very  extraordinary  fymptom,  \vh:ch  has  not  hitherto 
been  explained.  It  fomctimes  accompanies  every  ceflation  of  the 
uterine  diicharge,  but  frequently  appears  in  the  mod  violent  degree 
in  pregnancy.  In  young  women,  the  appetite  for  chalk,  lime,  rub- 


OF     PHYSIC.     .  *$ 

lour,  becoires  pale,  and  fometimes  of  a  yellowifii  hue  ; 
the  whole  body  becomes  pale  and  flaccid;  and  the 
feet,  ana  j..*v  hap>  ado  a  great  part  of  the  body,  become 
affecled  \vith  cedematous  fwelling.  The  breathing  is 
hurried  by  any  quick  or  laborious  motion  of  the  body 
and  the  heart  is  liable  to  palpitation  and  fyncope. — 
A  headach  fometimes  occurs ;  but  more  certainly 
pains  of  the  back,  loins,  and  haunches*. 

M. 

Thefe  fymptoms,  when  occurring  in  a  high  degree, 
conilimte  the  chlorojls  of  authors,  hardly  ever  appear- 
ing feparate  from  the  retention  of  the  menfes  ;  and, 
attending  to  thefe  fymptoms,  the  caule  of  this  reten- 
tion may,  I  think,  be  perceived. 

Thefe  fymptoms  manifeftly  (how-  a  confiderable  lax- 
ity and  flaccidity  of  the  whole  fyftem  ;  and  therefore 
give  reafon  to  conclude,  that  the  retention  of  the  men- 
fes accompanying  them,  is  owing  to  a  weaker  aclion 
of  the  vefTels  of  ihe  uterus;  which  therefore  do  not 
impel  the  blood  into  their  extremities  with  a  force 
fufficient  to  open  thefe,  arid  pour  out  blood  by  them. 

MI. 

How  it  happens  that  at  a  certain  period  of  life  m 
flaccid;  iy  of  the  fyftem  arifes  in  young  women  not 
originally  afFe&ed  with  any  fuch  weaknxrfs  or  laxity  ^ 
and  of  which  but  a  little  time  before,  they  h.id  given 
no  indication,  may  be  diiBcult  to  explain ;  but  I 
wouid  attempt  it  in  this  wuy. 

Ab  a  certain  (late  of  the  ovaria  in  females,  prepares 

d::pnie3  them  to  the  cxerclie  of  veiiery,  about  the 

very  period  at  which  the  menfes  ill  ft  appear,  it  is  to  be 

pre- 

bifli,  charcoal,  and  various  abforbents,  is  the  moft  prevalent.  Stall), 
and  his  followers,  made  great  life  of  this  circnmfUnce  in  fuppcrtin^ 
their  favourite  opinion  of  the  vis  inedicatnx  naturce. 

Thefe  pains  are  not  properly  fymptoms  of  the  tlifeafe,  but 
but  prognoiltcs  of  the  efforts  nature  makes  to  remove  the  difeafe  : 
They  are  fymptoms  of  the  vis  medicatrix. 


2/r  PRACTICE 

prefumed,  that  the  flate  of  the  ovaria  and  that  of  the 
uterine  vcfiels  are  in  fome  meafure  connected  toge- 
ther ;  and  as  generally  fymptoms  of  a  change  in  the 
Hate  of  the  former  appear  before  thoie  of  the  latter, 
it  may  be  inferred  that  the  flate  of  the  ovaria  has  a 
great  mare  in  exciting  the  action  of  the  uterine  veilcls 
and  producing  the  mentlrual  flux.  But  analogous  to 
what  happens  in  the  male  fex,  it  may  be  prefumed, 
that  in  females  a  certain  ftate  of  the  genitals  is  necef- 
fary  to  give  tone  and  tcnfion  to  the  whole  iyftem  ;  and 
therefore  that,  if  the  flimulus  ariilng  from  the  geni* 
tals  be  wanting,  the  whole  fyftem  may  fall  into  a  tor- 
pid  and  flaccid  fcate,  and  from  thence  the  chlorpfisand 
retention  of  the  mcnfcs  may  arife. 

MIL 

It  appears  to  me,  therefore,  that  the  retention  of 
the  menfes  is  to  be  referred  to  a  certain  flate  or  affec- 
tion of  the  ovaria:  but  what  is  precifely  the  nature  of 
this  affection,  or  what  are  the  caufesof  it,  I  will  not 
pretend  to  explain  ;  nor  can  I  explain  in  what  man- 
ner that  primary  caufe  of  retention  is  to  be  removed. 
In  this,  therefore,  as  in  many  other  cafes,  where  we 
cannot  affign  the  proximate  caufe  of  difeafes,  our  in- 
dications of  cure  mull  be  formed  for  obviating  and 
removing  the  morbid  effects  or  fymptoms  which  ap- 
pear. 

,MIIL 

The  effects,  as  has  been  faid  in  M.  confift  in  a  ge- 
neral flaccidity  of  the  fyftem,  and  confequently  in  a 
weaker  action  of  the  vellels  of  the  uterus  ;  fo  that  this 
debility  may  be  coniidered  as  the  more  immediate 
caufe  of  the  retention.  This,  therefore,  is  to  be  cur- 
ed by  reftoring  the  tone  of  the  fyilem  in  general,  and 
by  exciting  the  action  of  the  uterine  veffels  in  parti- 
cular. 

MIV. 

The  tone  of  the  fyftem  in  general  is  to  be  reftored 

by 


OF    PHYSIC.  23 

by  exercife,  and  in  the  beginning  of  the  difeafe,  by 
cold  bathing.  At  the  fame  time,  tonic  medicines* 
may  be  employed  ;  and  of  thefe  the  chaiybeutes  have 
been  chiefly  recommended. 

MV. 

The  acYion  of  the  veiTels  of  the  titerus  may  be  ex- 
cited : 

ift,  By  determining  the  blood  into  them  more  co- 
pioufly  ;  which  is  to  be  done  by  determining  the  blood 
into  the  defending  aorta,  by  purging,  by  the  exer- 
cife pf  walkingf,  by  fiiaion,  and  by  warm  bathing  of 
the  lower  extremities.  It  is  alfo  probable  that  the 
blood  may  be  determined  more  copioufly  into  the  hy- 
pogaftric  arteries  which  go  to  the  uterus,  by  a  com- 
preffion  of  the  iliacs ;  but  the  trials  of  this  kind  hi- 
therto made  have  feldom  fucceeded. 

MVI. 

idly,  The  action  of  the  uterine  vefTels  may  be  ex- 
cited by  ftimulants  applied  to  them.  Thus  thofe 
purgatives  which  particularly  fthnulate  the  inteflinum 
reclumj,  may  alfo  prove  ftin-ulant  to  the  uterine  vef- 

VOL.  II.  D  ft  Is 

*  Forms  of  the  tonic  medicines  have  been  given  in  Come  of  the 
preceding  notes.  The  electuary  in  the  note  on  article  983.  is  fre- 
quently ufed  with  fucceis.  In  this  cafe,  we  mult  not  uie  a  ringents, 
but  tonics,  and  confequently  only  fuch  tonics  as  are  not  aflringcnts, 
at  lealt  in  a  high  degree.  I  he  fimple  bitter  tonics  frequently  an- 
fvver  where  the  fymptoms  are  not  fevere.  The  infufum  gentians 
compofiturn  of  the  new  London  Pharmacopoeia  is  a  good  formula. 
The  dofe  of  it  is  two  ounces  twice  a  clay,  or  oftener,  if  the  ilomach, 
can  bear  it.  Chalybeates  are  abfolutely  neceflary  if  the  difeafe  with- 
ftands  the  ufe  of  bitters;  they  may  be  given  iu  any  of  the  forms 
mentioned  in  the  preceding  notes. 

f  Dancing  is  alfo  a  proper  exetcife  in  this  difeafe- 
j  The  ftimulant  purges  are  in  general  the  draftic  refins,  as  Soem- 
mony,  Aloes,  &c.  Various  formulae  of  them  have  been  recommend- 
ed in  thefe  cafes  ;  the  pilulx  Rufi  is  commonly  ufed  with  good  tf- 
fe&.  It  may  be  given  in  the  quantity  of  half  a  drachm,  or,  in  ftrong; 
constitutions,  two  fcruples.  It  ought  not  to  be  repeated  above 
twice  a  week  ;  and,  in  the  intermediate  days,  we  may  employ  the 
tonic  medicines  above  mentioned.  The  Pilulse  ecphradticse  of  the 


26  PRACTICE 

fels  connected  with  thofe  of  the  reftum.  The  exer- 
cife  of  venery  certainly  proves  aflimulus  to  the  vefTels 
of.  the  uterus  ;  and  therefore  may  be  ufeful  when,  with 
propriety,  it  can  be  employed.  The  various  medi- 
cines recommended  as  flimulants  of  the  uterine  vef- 
feis,  under  the  title  of  Emmenagogues,  have  never 
appeared  to  me  to  be  effectual ;  and  i  cannot  perceive 
that  any  of  them  are  poiTeiTed  of  a  fpecific  power  in 
this  refpect.  Mercury,  as  an  univerful  ftimulant,  may 
aft  upon  the  uterus,  but  cannot  be  very  fafely  em- 
ployed in  chlorotic  perfons.  One  of  the  moll  power- 
ful means  of  exciting  the  a&ion  of  the  verTels  in  every 
part  of  the  fyilcm  is,  the  elecl.ical  mock  ;  and  it  has 
often  been  employed  with  fuccefs  for  exciting  the  vef- 
fels  of  the  uterus. 

MVIL 

The    remedies    (MIII MVI.)  now   mentioned, 

are  thofe  adapted  to  the  retention  of  the  menfes;  and  I 

am 

Edinburgh  Pharmacopoeia  is  another  very  effectual  medicine  in  thefe 
calcs.  It's  dofe  is  half  a  drachrn  twice  a  week,  if  we  intend  to 
purge  b.iikly,  but,  by  giving  a  fmaller  quantity  as  ten,  twelve,  or 
fifteen  grains  once  a-ciay,  a  conttant  fttmuius  is  preferved,  which 
forne  'practitioners  prefer.  The  following  pills  are  alfo  much  re- 
commended : 

&.   Pil.  Giimmof. 

Aloes  Socotorin,  a  a,  311, 

Vin.  AJcet.   q   f. 

M.  f.  Mafia  in  pilulas  48  dividend. 

The  dofe  is  3  or  4  piils  at  bed  time. 

The  Tinctura  facra  is  alfo  frequently  ufed  as  a  brifk  purge  in  thefc 
cafes  ;  it's  dofe  for  thispurpoie.  mult  not  be  lefs  than  an  ounce  and 
a  half  in  mod  habits  ;  but  a  Ihong  conftitution  will  require  two 
ounces  or  more.  Oilier  ftimulants  than  purges  have  been  employed 
in  amenorrhoca,  as  the  tinclura  fabina  compolita  of  the  new  Lonaon 
Pharmacopoeia  ;  it's  dofe  is  thiity  or  forty  drops,  in  any  fuitable  ve- 
hicle, as  the  tin&ura  mynhac  of  the  fame  Pharmacopoeia,  in  dofes 
of  twenty  or  thirty  drops,  is  often  recommended  on  the  authority 
of  Boerhaave. 


OF    PHYSIC.  27 

am  next  to  consider  the  cafe  ^fuppreffion.  In  enter- 
ing upon  this,  I  mud  ohferve,  that  every  interruption 
of  the  iiux,  after  it  has  once  taken  place,  is  not  to  be 
conlidered  as  a  cafe  of  fuppreffion.  For  the  tiux,  up- 
on its  firfl  appearance,  is  not  always  immediately  eila- 
blifhed  in  its  regular  courfe  ;  and  therefore,  if  an  in- 
terruption happen  foon  after  the  firfl  appearance,  or 
even  in  the  courfe  of  the  firft,  or  perhaps  fecond  year 
after,  it  may  often  be  confidered  as  a  cafe  of  reten- 
tion, efpecially  when  the  difeafe  appears  with  the 
fymntoms  peculiar  to  that  (late. 

MV1II. 

Thofe  which  may  be  properly  confidered  as  cafes 
offupprefiion,  are  fuch  as  occur  after  the  flux  has  been 
for  fome  time  efhiblifhed  in  its  regular  courfe,  and  in 
which  the  interruption  cannot  be  referred  to  the  cr.uf- 
es  of  retention  (MII,  MIU.)  but  niufl  be  impute 
fome  refinance  in  the  extremities  of  the  veifels  of  the 
uterus.  Accordingly,  \ve  often  find  the  fuppreffion 
induced  by  cold,  fear,  and  other  caufes  which  may 
produce  a  confr.ricr.ion  of  thefe  extreme  veflels.  Some 
phylicians  have  fuppofed  an  obilructing  lentor  of  the 
fluids  to  occafion  the  refinance  now  mentioned  :  but 
this  is  purely  hypothetical,  without  any  proper  evi- 
dence of  the  fact;  and  it  is  beilues,  from  other  conii- 
derations,  improbable. 

MIX. 

There  are  indeed  fome  cafes  of  fuppreffion  that  feeni 
to  depend  upon  a  general  debility  of  the  fyftem,  and 
confequently  of  the  veflels  of  the  uterus.  Eat  in  fuch 
cafes,  the  fuppreffion  always  appears  as  fymptomatic  of 
other  affections,  and  is  therefore  not  to  be  confidered 
here. 

MX. 

The  icHopathic  cafes  of  fuppreffion  (MV-II  i .) "  feldom 
continue  long  without  being  attended  with  various 
fymptoms  or  diforders  in  different  parts  of  the  body  ; 

D  2  very 


2$  PRACTICE 

very  commonly  arifing  from  the  blood  which  fhould 
haAc  puffed  by  the  uterus,  being  determined  more  co- 
picufly  into  other  parts,  and  very  often  with  fuch 
force  as  to  produce  hemorrhagies  in  thefe.  Hence 
hemorrhagies  from  the  nofe,  lungs,  ftomach,  and  other 
parts,  have  appeared  in  confequence  of  fupprefTed 
menfes.  B~fides  thefe,  there  are  commonly  hyiteric 
and  dyfpeptic  fymptoms  produced  by  'he  fame  caufe ; 
raid  frequently  colic  pains,  with  abound  belly. 

MXI. 

In  the  idiopathic  cafes  of  fupprcffion,  (MVII.)  the 
indication  of  cure  is  to  remove  the  conftridion  affec~l- 
ing  the  extreme  vefTels  of  the  uterus;  and  for  this  pur- 
pole,  the  chief  remedy  h  warm  bathing  applied  to  the 
rci/ic  n  of  the -uterus.  This,  however,  is  not  always 
etixctua],  and  I  do  not  know  of  any  other  remedy  a- 
dapted  to  the  indication.  Befides  this,  we  have  per- 
haps no  other  means  of  removing  the  conftridion  in 
fault,  but  that  of  increafing  the  action  and  f;>rce  of 
the  veffels  of  the  uterus,  fo  as  thereby  to  overcome  the 
x\- litl  an  ce  or  conduction  of  their  extremities.  This 
therefoic  is  to  be  attempted  by  the  fame  remedies  in 
the  cafe  of  fupprefiion,  as  thofe  prefcribed  in  the  cafes 
of  retention  (MIV — MVI.)  The  tonics,  however,  and 
cold  bathing  (MIV.)  ftem  to  be  lefs  properly  adapted 
to  the  cafts  of  fupprefiion,  and  have  appeared  to  me 
oj  ambiguous  eftecl*. 

MXII. 

*  The  Emenagogues  enumerated  in  the  note  on  article  100$, 
are  move  efficacious  in  thtfe  cafes  than  the  tonics  and  chalybeates 
mentioned  in  the  note  on  article  1004,  for  this  reafon,  that  the 
fuppreffion  of  the  n;c.,frs  depends  more  on  the  conftri&ion,  than  on 
a  laxity  cf  the  extreme  veflcls.  Some  cafes  indeed,  occur,  where  a 
lax  habit  is  the  caufe  of  fuppreflion,  but  they  are  rare-  The  phy- 
iicians  ought  to  be  attentive  in  difcriminating  fuchc^fes,  becaufe  a 
liberal  ufe  of  forcing  emenagogu:-s  is  always  hurtful  in  them  j  they 
can  cnir  be  relieved  by  tonics,  and  efpecially  by  chalybeates. 


O  F    P  H  Y  S  I  C.  29 

MXII. 

It  commonly  happens  in  the  cafes  of  fupprefilon, 
that  though  the  menfes  do  not  flow  at  their  ufual  pe- 
riods, there  are  often  at  thofe  pe.iods  fomc  marks  of 
an  effort  having  a  tendency  to  produce  the  difcharge. 
It  is  therefore  at  thofc  times  efi;ecially  when  the  ef- 
forts of  the  fyftem  are  concurring,  that  we  ought  to 
employ  the  remedies  for  curing  a  fuppreffion  ;  and  it 
is  commonly  fruitlefs  to  employ  the-n  at  other  times, 
unlefs  they  be  fuch*  as  require  fornc  continuance  in 
their  ufe  to  produce  their  effects. 

Mxnr. 

Nearly  fimilar  to  the  cafes  of  fuppreflion,  are  thofc 
cafes  in  which  the  menfes  flow  after  longer  intervals, 
and  in  leffer  quantity  than  ufual;  and  when  thefe  caf- 
es are  attended  with  the  diforders  in  the  fyitem  (MX.) 
they  are  to  be  cured  by  the  fame  remedies  as  the  caf- 
es of  entire  fuppreffion. 

MXIV, 

It  may  be  proper  in  this  place  to  take  notice  of  the 
defmenorrhea,  or  cafes  of  menftruation  in  which  the 
menfes  feern  to  flow  with  difficulty,  and  are  accompa- 
nied with  much  pain  in  the  back,  loins,  and  lower 
belly.  We  impute  this  diforder  partly  to  fome  weak- 
er adlion  of  the  veffels  of  the  uterus,  and  partly?  per- 
haps more  efpecially,  to  a  fpafm  of  its  extreme  veffels. 
We  have  commonly  found  the  difcafe  relieved  by  em- 
ploying fome  of  the  remedies  of  fuppreffion  immecli- 
ately  before  the  approach  of  the  period,  and  at  the 
fame  time  employing  opiates. 

CHAR 

•'•  Viz,  tonics  or  alterants. 


PRACTICE 

CHAP.      IX. 

OF  SYMPTOMATIC  HEMORRHAGIES. 

MXV. 

HAVE  thought  it  very  improper  in  this  work,  to 
treat  of  thofe  morbid.afFe&ions  that  are  almoft  al- 
ways fymptomatic  of  other  more  primary  difeafes  ; 
and  this  for  leveral  reafons,  particularly  becaufe  it 
introduces  a  great  deal  of  confufion  in  directing  prac- 
tice, and  leads  phylicians  to  employ  palliative  mea- 
fures  only.  I  (hall  here,  However,  deviate  :i  little  from 
my  general  plan,  to  make  foine  reflections  upon 
fyinptomatic  hemorrhagies. 

MXVI, 

The  hemorrhagies  of  this  kind  that  efpecially  de- 
ferve  our  notice,  are  the  Hematemefis,  or  Vomiting 
of  Blood  ;  and  the  Hematuria,  or  the  Voiding  of 
Bloocl  from  the  urinary  pafTage.  Upon  thefe  I  am 
here  to  make  ibme  remarks  ;  becauie,  though  they 
are  very  generally  fymptomatic,  it  is  poilible  that  they 
may  be  f.-metirnes  primary  and  idiopathic  nfFedions  ; 
and'becaufe  they  have  been  treated  of  as  primary  dif- 
cafes  in  almoil  every  iyftem  of  the  practice  of  phy- 
ilc. 


SECT.     I. 

OF  THE  HEMATEMESIS,    OR  VOMITING 
OF  BLOOD. 

.       MXVII. 

HAVE  faid  above  (in  DCCCCXLV.)  in  what  man- 
ner blood  thrown  out  from  the  mouth  may  be 

known 


OF    PHYSIC;  31 

known  to  proceed  from  the  ftomach,  and  not  from 
the  lungs :  but  it  may  be  proper  here  to  lay  more  par- 
ticularly, that  this  may  be  certainly  known,  when  the 
blood  is  brought  up  manifeftly  by  vomiting  without 
any  coughing  ;  when  this  vomiting  has  been  preceded 
by  fome  fenie  of  weight,  anxiety,  and  pain,  in  the  re- 
gion of  the  ftomach ;  when  the  blood  brought  up  is 
of  a  black  and  grumous  appearance,  and  when  it  is 
manifeftly  mixed  with  other  contents  of  the  ftomach  ; 
we  can  feldom  have  any  doubt  of  the  fource  from 
whence  the  blood  proceeds,  and  therefore  of  the  exift- 
ence  of  the  difeafe  we  treat  of. 
MXVIII. 

We  muft  allow  it  to  be  poilible  that  a  plethoric 
ftate  of  the  body  from  general  caufes  may  be  accom- 
panied with  caufes  of  a  peculiar  determination  and 
aiHux  of  blood  to  the  ftomach,  fo  as  to  occafion  an 
hemorrhagy  there,  and  thence  a  vomiting  of  blood  j 
and  in  fuch  a  cafe  this  appearance  might  be  confider- 
ed  as  a  primary  difeafe.  But  the  hiitory  of  difeafes 
in  the  records  of  phyfic,  afford  little  foundation  for 
fuch  a  fuppofition ;  and  on  the  contrary,  the  whole 
of  the  inftances  of  a  vomiting  of  blood  which  have 
been  recorded,  are  pretty  manifeftly  fymptomatic  of  a 
more  primary  affection. 

Of  fuch  lymptomatic  vomitings  of  blood,  the  chief 
inftances  are  the  following. 

MXIX. 

One  of  the  moft  frequent  is  that  which  appears  in 
confequence  of  a  fuppreffion  of  an  evacuation  of  blood 
which  had  been  for  fome  time  before  ellablillied  in  a- 
nother  part  of  the  body,  particularly  that  of  the  men- 
lirual  fiux  in  women. 

MXX. 

There  are  inftances.  of  a  vomiting  of  blood  happen- 
ing from  the  retention  of  the  menfes  :  but  fuch  indanc.es 
arc  very  uncommon  j  as  a  retention  of  the  menfes 

rarely 


32  PRACTICE 

rarely  happens -in  confequence  of,  or  even  with,  a  ple« 
thoric  ftate  of  the  body  ;  and  as  rarely  does  it  produce 
that,  or  the  hemorrhagy  in  queftion. 

There  are  inftances  of  a  vomiting  of  blood  happen- 
ing to  pregnant  women  ;  that  might  therefore  alfo  be 
imputed  to  the  fupprefiion  of  the  menfes,  which  hap- 
pens to  women  in  that  (late.  There  have  indeed  been 
more  inftances  of  this  than  of  the  former  cafe ;  but 
the  latter  are  ftill  very  rare  :  for  although  the  blood 
which  ufed  to  flow  monthly  before  impregnation,  is, 
upon  this  taking  place,  retained,  it  is  commonly  fo  en- 
tirely employed  in  dilating  the  uterine  veflels,  and  in 
the  growth  of  the  foetus,  that  it  is  feldom  found  to 
produce  a  plethoric  ftate  of  the  body?  requiring  a  vi- 
carious outlet* 

The  vomiting  of  blood,  therefore,  that  is  vicarious 
of  the  menftruai  flux,  is  that  which  commonly  and  al- 
mofl  only  happens  upon  a  fuppreflion  of  that  flux,  af- 
ter it  had  been  forfome  time  eftabliihed. 

MXXL 

When  fuch  a  fuppreflion  happens,  it  may  be  fup- 
pofed  to  operate  by  inducing  a  plethoric  ftate  of  the 
whole  body,  and  thereby  occasioning  hemorrhagy  from 
other  parts  of  it ;  and  hemorrhagies  from  many  dif- 
ferent parts  of  the  body  have  been  obferved  by  phy- 
ficians  as  occurring  in  confequence  of  the  fuppreflion 
we  fpeak  of.  It  is  however  the  great  variety  of  fuch 
hemorrhagies,  that  leads  me  to  think,  that  with  the 
plethoric  ftate  of  the  whole  body  there  muft  be  always 
ibme  peculiar  circumftances  in  the  part  from  which 
the  blood  flows,  that  determine  its  afflux  to  that  par- 
ticular, often  fingularly  odd- part ;  and  therefore,  that 
fuch  hemorrhagies  may  from  thefe  circumftances  occur 
without  any  confiderable  plethora  at  the  fame  time  pre- 
vailing in  the  whole  fyftem. 

MXXIL 


O  F*    P  H  Y  S  I  &  33 

MXXII. 

It  is  to  be  obferved,  that  if  we  are  to  exped  an  he- 
fcnorrhagy  in  confequence  of  a  fupprefiion  of  the  menfes 
inducing  a  plethoric  ftate  of  the  fyftem,  we  fhould  ex- 
pect efpecially  an  hemoptyiis,  or  hemorrhagy  from  the 
lungs,  as  a  plethora  might  be  expected  tofnovvits  effects 
efpecially  there  ;  and  accordingly,  upon  occaiion  of 
fupprefled  menfes,  that  hemorrhagy  occurs  more  fre- 
quently than  any  other  :  but  even  this,  when  it  does 
happen,  neither  in  itscircumftances  nor  its  confequen- 
ces,  leads  us  to  fuppofe,  that  at  the  fame  time  any  con- 
fiderable  or  dangerous  plethora  prevails  in  the  body* 

MXXIII. 

Thefe  coniiderations  in  MXXI.  MXXII.  will,  I  ap- 
prehend, apply  to  our  prefent  fubject;  and  I  would 
therefore  allcdge,  that  a  hematemefis  may  perhaps 
depend  upon  particular  crrcumftanees  of  the  ftomach 
determining  an  afflux  of  blood  to  that  organ,  and  may 
therefore  occur  without  any  Copfiderable  or  dangerous 
plethora  prevailing  in  the  fyftem.  What  are  the  cir- 
cumftances  of  the  ftomach,  which  upon  the  occaiion 
mentioned,  may  determine  an  afflux  of  blood  to  it,  I 
cannot  certainly  or  clearly  explain  ;  but  prefume  that 
it  depends  upon  the  connection  and  confent  which  we 
know  to  fubfift  between  the  uterus  and  the  whole  of 
the  alimentary  canal,  and  efpecially  that  principal  part 
of  it  the  ilomach* 

MXXIV. 

From  thefe  reflections,  we  may,  I  think,  draw  the 
following  conclufions  : 

I.  That  the  hematemeiis  we  fpcak  of  is  I  ,ver 
a  dangerous  difeafe. 

II.  That  it  will  hardly  ever  require  the  remedies  fait* 
ed  to  the  cure  of  a&ive  hemorrhagy  j  and  at  lead  that 
it  will  require   thefe  only  in  thofe  unufaal  cafes  in 
which  there  appear  ftrong  marks  of  a  general  plethora, 

VOL,  II.  E  and 


34  P  R  A  C  T  I  G  E 

and  in  which  the  vomiting  of  blood  appear  $  to  be  con- 
iiderably  active,  very  profufe,  and  frequently  recurring. 

III.  That  a  vomiting  of  blood  from  fuppreiTed  menf- 
es,  ought  feidom  to  prevent  the  ufe  of  thefe  remedies 
of  amenorrhoea,  which  might  be  improper  in  the  cafe 
©f  an  active  idiopathic  hemorrhagy. 
MXXV. 

Another  cafe  of  fymptomatic  hematemefis  quite 
analogous  to  that  already  mentioned,  is  the  hemate- 
rnciis  following,  and  feemingly  depending  upon,  the 
fuppreilion  of  an  hemorrhoidal  flux,  which  had  been 
eilabliihed  and  frequent  for  fome  time  before. 

This  may  perhaps  be  explained  by  a  general  ple- 
thoric ilate  induced  by  fuch  a  fuppreflion ;  and  indeed 
fome  degree  of  a  plethoric  ilate  muft  in  fuch  a  cafe  be 
fuppcfed  to  take  place ;  but  that  fuppofition  alone 
\villnot  explain  the  whole  of  the  cafe  ;  for  a  general 
plethora  would  lead  us  to  expect  an  hemoptyfis  (MXX- 
ii.)  rather  than  an  hematemefis ;  arid  there  is  there- 
fore fomething  ft  ill  wanting,  as  in  the  former  cafe,  to 
explain  the  particular  determination  to  theftornach. 

Whether  fuch  an  explanation  can  be  got  from  the 
connection  between  the  different  parts  of  the  fangui- 
ferous  veffels  of  the  alimentary  canal,  or  from  the 
connection  of  the  whole  of  thefe  vefTels/with  the  ve- 
na portarum,  1  lhall  not  venture  to  determine.  But 
in  the  mean  time  I  imagine  that  the  explanation  re- 
quired is  rather  to  be  obtained  from  that  connection 
of  the  ftbmach  with  the  hemorrhoidal  affection  that  I 
have  taken  notice  of  in  DCCCCXLVI. 
MXXVI. 

However  we  may  explain  the  hematemefis  occafi- 
oned  by  a  fupprcffion  of  the  hemorrhois,  the  conge- 
lations in  MXXI.  Mxxn.  will  apply  here  as  in  theana- 
logous  cafe  of  hematemefis  from  fupprefTed  menfes  ; 
and  will  therefore  allow  us  alfo  to  conclude  here,  that 

the 


OFF  H  Y  S  I  C.  35 

the  diicafc  we  now  treat  of  will  feldom  be  dangerous, 
and   will  feldom  require  the  lame  remedies  that  idio- 
pathic  and  a&ive  hemorrhagia  does, 
MXXVII. 

The  cafes  of  hematcmefis  already  mentioned,  may 
be  properly  fuppofed  to  be  hemorrhagies  of  the  arterial 
kind  ;  but  it  is  probable  that  the  ftomach  is  alfo  liable 
to  hemorrhagies  of  the  venous  kind.  (DCCLXVIU.) 

In  the  records  of  phyfic  there  are  many  in  fiances  of 
vomitings  of  blood,  which  were  accompanied  with 
a  tumefied  fpleen,  which  had  comprefled  the  vas 
breve,  and  thereby  prevented  the  free  return  of  venous 
blood  from  the  ftomach.  How  fuch  an  interruption 
of  the  venous  blood  may  occafion  sn  hemcrrhagy 
from  either  the  extremities  of  the  veins  them/elves, 
or  from  the  extremities  of  their  correfpondent  arte- 
ries, we  have  explained  above  in  DCCLXIX.  and  the 
hiftories  of  tumefied  fpleens  comprefiing  the  vafa  bre- 
via,  afford  an  excellent  illuflration  and  confirmation 
of  our  doctrine  on  that  fubjecl:,  and  render  it  fuffici- 
ently  probable  that  vomitings  of  blood  often  arife 
from  fuch  a  caufe. 

MXXVIJI. 

It  is  alfo  poffible,  that  an  obftrucrion  of  the  liver, 
refifling  the  free  motion  of  the  bluod  in  the  vena  por- 
tarum,  may  fonietimes  interrupt  the  free  return  of 
the  venous  blood  from  the  veflels  of  the  ftomach,  and 
thereby  occafion  a  vomiting  of  blood  ;  but  the  in- 
fiances  of  this  are  neither  ib  frequent  nor  fo  clearly 
explained  as  thofe  of  the  former  cafe. 
MXXIX, 

Befides  thefe  cafes  depending  on  the  ftate  of  the  li- 
ver or  fpleen,  it  is  very  probable  that  other  hemor- 
rhagies of  the  ftomach  are  frequently  of  the  venous, 
kind, 

The  difeafe  named  by  Sauvages  Mehena,  and   by 
j-  2  other 


36  P  R  A  C  T  I  C  E 

other  writers  commonly  termed  the  Morbus  Niger 
(DCCLXXII.)  coniifting  in  an  evacuation  either  by  vo- 
miting or  (tool,  and  fometimes  in  both  ways,  of  a 
black  and  grumous  blood,  can  hardly  be  otherwife 
occaiioned,  than  by  a  venous  hemorrhagy  from  fome 
part  of  the  internal  furface  of  the  alimentary  canal. 

It  is,  indeed,  poffible,  that  the  bile  may  fometimes 
put  on  a  black  and  vifcid  appearance,  and  give  a  real 
foundation  for  the  appellation  of  an  Atra  Bilis  :  but 
it  is  certain,  that  infiances  of  this  are  very  rare  ;  and 
it.  is  highly  probable  that  what  gave  occaiion  to  the 
notion  of  atra  bilis  among  the  ancients,  was  truly  the 
appearance  of  blood  poured  into  the  alimentary  canal 
in  the  manner  I  have  mentioned  ;  and  which  appear- 
ance, we  know,  the  blood  always  puts  on  when  it  has 
ftagnared  therefor  any  length  of  time.  I  fuppofe  it- 
is  now  generally  thought,  that  JBoerhaave's  notion  of" 
fuch  a  matter  exilling  in  the  mafs  of  blood,  is  without 
any  foundation  ;  whilft,  by  directions  in  modern  times, 
it  appears  very  clearly,  that  the  morbus  nigerprefent- 
ing  fuch  an  appearance  of  blood,  always  depends  up- 
on the  effuiion  and  ftagnation  I  have  mentioned. 

MXXX. 

From  this  account  of  the  melaena  it  will  appear, 
that  vomitings  of  blood  may  arife  in  confequence  of 
blood  being  poured  out  in  the  manner  I  have  menti- 
oned, either  into  the  cavity  of  the  ftomach  itfelf,  or 
into  the  fuperior  portions  of  the  interlines,  from  whence 
matters  often  pafs  into  the  flomach. 

MXXXI. 

Both  m  the  cafe  of  the  Melaena,  and  in  the  analo- 
gous cafes  from  affections  of  the  fpleen  or  liver,  it  will 
appear,  that  the  vomitings  of  blood  occurring  muft  be 
confidered  as.  fymptomatic  affections,  not  at  all-  to  be 
Created  as  a  piimary  active  hemorrhagy,  but  by  reme- 
dies 


OF    PHYSIC.  37 

dies,  if  any  fuch  be  known,  that  may  refolve  the  pri- 
mary obftru&ions*. 

MXXXIL 

I  believe  I  have  now  mentioned  almoft  the  whole 
of  the  caufes  producing  a  hernatemefis  ;  and  certainly 
thecaufes  mentioned,  are  thofe  which  mod  common- 
ly give  occalion  to  that  fymprom.  Poffibly,  however, 
there  may  be  fome  other  caufes  of  it,  fuch  as  that  iin- 
gular  one  mentioned  by  Sauvages,  of  an  aneurifm  of 

the 

*  This  is  doiibtlefs  the  moft  rational  practice,  namely,  to  refolve 
the  obftru&ion  which  has  occafioned  the  blood  to  be  thrown  or 
driven  to  the  inteftines.  To  difcover  this  primary  obltruftion  is, 
however,  extrenaely  difficult;  and,  even  when  it  is  difcovered,  it  is. 
frequently  not  eafilyrefolved  ;  in  fuch  cafes,  therefore,  we  mull:  ufe 
the  general  remedies  for  removing  the  plethora,  except  laxatives, 
,  the  operations  of  which,  in  general,  derive  the  fluids  to  the  intef- 
tines. Sweating  is  perhaps  the  belt  general  evacuation  for  deter- 
mining the  fluids  from  the  inteftines  ;  but  it's  ufe  ought  to  be  pre- 
ceded by  bleeding:  and  it  ought  not,  in  thefe  cafes,  to  be  excited 
by  naufeating  dofes  of  emetics,  as  thefe  produce  the  fame  effect  as 
laxatives  ;  we  mull  therefore  have  recourfe  to  the  light  aromatics, 
Jage,  mint,  balm,  wine-whey,  &c.  Camphor  and  opium  are  alfo 
proper  fudoriiks  in  thefe  cafes.  They  may  be  given  together,  as 
in  the  following  bolus  : 

.&   Camphor,  gr.  vi. 
Spr.   vinigutt.  x. 
Opii  pur.  gr.  i. 
Conf,  card.  ^fs.  vel.  q.  F. 
M.  f.  bolus, 

Some  pra&itiontrs  have  recommended  large  quantities  of  fperma- 
ceti  in  cafes  of  hernatemefis,  and  not  without  reafon.  It  may  be 
given  in  emulfions,  with  yolks  of  eggs,  or  in  an  ekauary.  I  mail 
therefore  add  a  formula  of  each. 

&.  Spermat.  cet.    |fs. 
Vitel.  ovi  q.  f. 

Tere  in  mortar,  marmoreo,  et  adde 
Aiq.  font.    f}. 
Styr.  fimpl.  ^i. 
M.  f.  Emulf. 

'The  dofc  of  this  emulfion  is  two  or  three  table 'fpoonfulls  every  three 
kourt, 


38  P  R  A  C  T  I  C  E 

the  aorta  burfting  in  to  the  ftomach  :  and  it  is  pofiiblc 
that  fome  difeafes  of  other  contiguous  parts,  which 
have  become  clofely  adhering  to  the  ftomach,  may  ^ 
fometimes,  by  a  rupture  into   the  cavity  of  the  fto- 
rnach,  pour  blood  into  it,   which   is  afterwards  re- 

jcded 

§,     Spermat.  cct.  gi, 

Confcrv.  roiar.  ^ii. 
o 

Syr.  fimp.  ^i. 
M.  f.elea. 

The  dofe  of  this  ele&uary  is  *  tca-fpoonfull  or  two  every  two  or 
three  hours. 

If  the  hematemefis  be  violent,  we  muft  have  recourfe  to  fome  of 
the  ilyptics  and  aftringents  mentioned  before  in  the  cure  of  hemor- 
rhage in  genera!,  as  alum,  catechu,  kino,  &c.  of  which  I  fliall  fub- 
joiiifomc  formulae. 

R.  Alum.  u(h  gr.  iii. 
Kino  3fs. 
M.  f.  Pulvis. 

This  powder  may  be  icpeated  every  two   hours,    and    three  table- 
fpoonfuls  of  the  tincture   of  rofes  may  be  given  to  wafli  it  down. 

The  ele&uarium  japonicum  of  the  Edinburgh  Pharmacopoeia  is 
well  calculated  for  thefe  cafes  ;  it's  dofe  is  a  drachm  and  a  half,  or 
two  drachms.  The  extract  qf  logwood  is  fometimes  ufed  in  thefc 
dofes  with  confiderable  fuccefs.  It  may  either  be  given  alone  in 
dofes  of  a  fcruple  each  every  three  hours,  or  joined  with  alum,  as  in, 
the  following  formula. 

R.  Extract,  lign.  Campechenf.   3fs. 
Alum.  uft.  gr.  iii 
M,  f.  p ul vis. 

This  powder  may  be  repeated  every  three  hours;  drinking  after  it 
three  tabie-fpoonfulls  of  the  tindure  of  rofes  :  or  a  tea-cup  full  of 
cold  water,  with  twenty  or  thirty  drops  of  the  acid um  vitriolicurn 
dilutum,  or  as  much  as  is  fufficient  to  give  an  agreeable  acidity. 
All  thtfe  flyptica  and  aftringents  are  apt  to  produce  coftivenefs 
which  muft  be  removed  by  emollient  clylters,  as  laxative  medicines 
are,  for  the  reafons  above  mentioned,  generally  hurtful  in  thefe  ca- 
fes. The  young  practitioner  muft  not  trull  to  thefe  medicines  for 
completely  curing  an  hemorrhage  from  the  inteftine*  ;  they  are  only 
palHatives,  and  are  of  no  other  ufe  than  to  check  the  violence  of 
the  difchargc  until  the  true  caufe  of  the  difeafe  be  difcovered  ;  and 
the  difcovery  of  this  caufe  mull  be  left  to  the  fagacity  of  the  phyl!-> 
<nan. 


O  F    P  H  Y  S  I  C.  39 

je&ed  by  vomiting.  It  is  pollible,  alfo,  that  abfceiles 
and  ulceraiionsof  the  doinach  itfelf,  may  fometimes 
pour  blood  into  its  cavity  to  be  thrown  up  by  vomiting. 
I  did  not  think  it  neceflary  among  the  iymptoma- 
tic  vomitings  of  blood,  to  enumerate  thole  from  ex- 
ternal violence,  nor,  what  is  analogous  to  it,  that 
which  arifes  from  violent  draining  to  vomit;  which 
laft,  however,  is  much  more  rare  than  might  be  ex- 
pected. In  either  of  thefe  cafes  the  nature  of  the  uif- 
eafe  cannot  be  doubtful,  and  the  management  of  it 
will  be  readily  underilood  from  what  has  been  deliver- 
ed above  with  refpect  to  moderating  and  retraining 
hemorrhagy  in  general. 


SECT         II. 

OF  THE  HEMATURIA,  OR  THE  VOIDING 

OF  BLOOD  FROM  THE  URINARY 

PASSAGE. 

MXXXIII. 

IT  is  ailed ged,  than  an  hernaturiahas  occurred  with- 
out any  other  fymptom  of  an  affedlion  of  the  kidneys  or 
urinary  palfages  being  prefent  at  the  fame  time ;  and 
as  this  happened  to  plethoric  perfons,  and  recurred  at 
fixed  periods,  fuch  a  cafe  has  been  fuppcfed  to  be  an 
inftance  of  idiopathic  hematuria,  and  of  the  nature  of 
thofe  active  hemorrhagies  I  have  treated  of  before. 

MXXXIV. 

I  cannot  pofitively  deny  the  exiflence  of  fucli  a 
eafe;  but  mud  obferve,  that  there  are  very  few  in-* 
fiances  of  fuch  upon  the  records  of  phyfic ;  that  none 
have  ever  occurred  to  my  obfervation,  or  to  that  of 
my  friends  ;  and  that  the  oblervations  adduced  may 
be  fallacious,  as  I  have  frequently  obferved  an  hema- 
turia without  fymptoms  of  oiher  affection  of  the  kid- 
ney 


40  PRACTICE 

ney  or  urinary  paffages  being,  for  the  time,  prefent  $ 
whilii,  however,  fits  of  a  nephralgia  calculofa  hav- 
imr,  before,  or  foon  after,  happened,  rendered  it  to  me 
fufficiently  probable,  that  the  hematuria  was  owing  to 
a  wound  made  by  a  ftone  prefent  in  fomepart  of  the  uri- 
nary paffages.  MXXXV. 

The  exillcnce  of  an  idiopathic  hematuria  is  further 
improbable,  as  a  general  plethora  is  more  likely  to 
produce  an  hemopcylis  (MXXII.)  and  as  we  do  not 
Well  know  of  any  circumstances  which  might  deter- 
mine more  particularly  to  the  kidneys.  An  idiopathic 
hematuria,  therefore,  mull  certainly  be  a  rare  occur- 
rence ;  and  inflances  of  fymptomatic  affections  of  the 
fame  kind  are  very  frequent. 

MXXXVI. 

One  of  the  moil  frequent  is,  that  hematuria  which 
attends  the  nephralgia  calculofa,  and  feems  manifeflly 
to  be  owing  to  a  Hone  wounding  the  internal  lurface 
of  the  pelvis  of  the  kidney  or  of  the  ureter.  In  fuch 
cafes,  the  blood  difcharged  with  the  urine  is 
fometimes,  of  a  pretty  florid  colour,  but  for  the  moft 
part  is  of  a  dark  hue  :  the  whole  of  it  is  fome* 
times  diffufed  or  diffulved,  and  therefore  entirely  fuf- 
pended  in  the  urine  ;  but  if  it  is  in  any  large  quan- 
tity, a  portion  of  it  is  depolited  to  the  bottom  of  the 
veffel  containing  the  voided  blood  and  urine.  On 
different  occafions,  the  blood  voided  puts  on  different 
appearances.  If  the  blood  poured  out  in  the  kidney 
has  happened  to  ftagnate  for  forne  time  in  the  ureters 
or  bladder,  it  is  fometimcs  coagulated,  and  the  coa- 
gulated partis  afterwards  broken  down  into  a  grumous 
mafs  of  a  black  or  dark  colour,  and  therefore  gives 
the  fame  colour  to  the  urine  voided;  or  if  the  quan- 
tity of  broken  down  blood  is  fmall,  it  gives  only  a 
browmfh  urine  refembling  coffee.  It  fometimes  alfo 
happens,  that  the  blood  llagnuting  and  coagulating 

in 


OF    PHYSIC.  41 

$h  the  ureters,  takes  the  form  of  thefe  vefTeIs3  and  is 
therefore  voided  under  the  appearance  of  a  worm  ; 
and  if  the  coagulated  blood  happens  to  have,  as  it 
may  fometimes  have,  the  glutten  Separated  from  the 
red  globules,  thcfe  worm-like  appearances  have  their 
external  furface  whitim,  and  the  whole  feemingly 
forming  a  tube  containing  a  red  liquor.  I  have  fome- 
times obferved  the  blood  which  had  feemingly  been 
coagulated  in  the  ureter^  come  away  in  an  almoft  dry 
ilate,  refembling  the  half- burnt  wick  of  a  candle*. 
MXXXVIL 

Theiearethe  feveral  appearances  of  the  blood  void- 
ed in  the  hematuriacalculofa,  when  it  proceeds  efpe- 
cially  fromthelddneys  orureter;  and  many  of  the  fame 
appearances  are  obferved  when  the  blood  proceeds 
only  from  the  bladder  when  a  ftone  is  lodged  there  ; 
but  the  attending  fymptoms  will  commonly  point  out 
the  different  feat  of  the  difeafe. 

In  one  cafe,  when  a  quantity  of  blood  from  the  kid- 
ney or  ureter  is  coagulated  in  the  bladder,  and  is  there- 
fore difficultly  thrown  out  from  this,  the  pain  and  un- 
eafinefs  on  fuch  an  occafion  may  appear  chiefly  to  be 
in  the  bladder,  though  it  contains  no  flone ;  but  the 
antecedent  fymptoms  will  commonly  difcover'the  na- 
ture of  the  difeafe. 

VOL.  II.  F  MXXXVIII. 

*  In  general,  the  blood  is  coagulated  and  grumous ;  hence  the 
urine  depofits  a  dark  brown  fubftance  fomewhat  refembling  coffee- 
grounds.  As  the  grumous  blood  is  fpecifically  heavier  than  the  u- 
rine,  it  falls  to  the  bottom  of  the  bladder,  and  is  consequently  voided 
in  greater  quantity  in  the  beginning  than  towards  the  end  of  mak- 
ing water,  the  urine  that  comes  off  firit  being  very  deep  coloured 
and  muddy,  but  becoming  while  it  flows,  gradually  more  tranfpa- 
rent  and  pure,  until  at  hit  it  is  perfectly  of  a  natural  appearance. 
The  patient  generally  mentions  this  circumflance  in  defcribing  his 
complaints,  with  this  addition,  that  he  has  in  the  beginning  fome 
difficulty  of  making  water,  but  that  this  difficulty  deereafes  in  pro- 
portion as  the  urine  becomes  more  tranfparent. 


42  PRACTICE 

MXXXVIII. 

In  any  of  the  cafes  of  th'e  hematuria  calculofa,  it 
will  hardly  be  necefTary  to  employ  the  remedies  fuited 
to  an  active  hemorrhagy.  It  will  be  proper  only  to 
employ  the  regimen  fit  for  moderating  hemorrhagy  in 
general,  and  particularly  here  to  avoid  every  thing 
or  circumflance  that  might  irritate  the  kidneys  or  ure- 
ters. Of  fucli  cafes  of  irritation  there  is  none  more 
frequent  or  more  confiderable  than  the  prefence  of  har- 
dened fasces  in  the  colon  ;  and  thefe  therefore  are  to 
be  frequently  removed,  by  the  frequent  ufe  of  gentle 
laxatives*. 

MXXXIX. 

The  hematuria  calculofaf  may  be  properly  eonii- 
dered  as  a  cafe  of  the  hematuria  violenta  :  and  there- 
fore I  fubjoin  to  that  the  other  inftances  of  hematuria 
frum  external  violence  ;  fuch  as  that  from  external 
contuiion  on  the  region  of  the  kidneyj,  and  that  from 

the 

*  Clyfters  are  preferable  to  purgatives  in  thefe  cafes,  becaufe 
they  are  k-fs  ilimu'ating  ;  and  the  emollient  clyflers  are  preferable 
to  all  others,  for  their  only  intention  istofofion  the  hardened  fasces. 
The  only  purgatives  to  be  ufed  are  thofe  of  the  mildeft  kind,  as 
manna,  oil,  caffia,  &c.  The  intention  of  purgatives,  in  thefe  cafes, 
is  only  to  remove  the  hardened  fasces;  and  this  intention  can  often 
be  fufficiently  anfwered  by  a  proper  choice  of  food,  as  broths,  ef- 
pecially  thofe  made  of  barley  and  young  animal  flefh  ;  barley-gruel, 
with  prunes  boiled  in  it  ;  ftewed  endive,  lettuce,  and  other  olerace- 
ous  difhes. 

•J-  Tiie  hematuria  calculofa  being  fymptomatic,  can  only  be  cur- 
ed by  removing  the  caufe  ;  it  may  however,  be  greatly  relieved  by 
demulcents,  as  linefeed-tea,  decoclions  of  mardimallows,  mucilage 
of  gum  Arabic,  thick  barley-water,  &c. 

j  The  hematuria  proceeding  from  a  contufion  of  the  region  of 
the  kidneys,  requires  general  and  topical  bleeding,  with  purge?,  and 
an  attention  to  the  antiphlogiilic  regimen.  Some  practitioners  re- 
co'.n:nend  the  warm  balfams  in  thefe  cafes;  but  on  account  of  their 
heating  quality,  their  ufe  is  fomewhat  doubtful.  Nitre  is  not  always 
admifiible,  on  account  of  its  irritating  the  kidneys  :  but  it  is  a  pow- 
erful antiphlogiilic  ;  and,  if  it  is  ufed  in  thefe  cafes,  it  rr.uft  be  well 


O  F    P  H  Y  S  I  C.  43 

the  violent  or  long  continued  exercife  of  the  mufcles 
incumbent  on  the  kidneys.  An  inftance  of  the  latter 
caufe  occurs  efpecially  in  riding*. 

MXL. 

Itmayalfobe  confidered  as  a  cafe  of  the  hematuria 
violenta,  when  the  difeafe  occurs  in  confequence  of 
the  taking  in  of  certain  acrid  fubftances,  which  pafs 
again  efpecially  by  the  urinary  paffages  ;  and,  by  in- 
flaming and  f welling  the  neck  of  the  bladder,  bring  on 
a  rupture  of  the  over-did  ended  blood-veflels,  and  give 
occafion  to  a  bloody  urine.  The  mod  noted  inftance 
of  this  is  in  the  effedl  of  cantharides  in  a  certain  quan- 
tity, any  way  introduced  into  the  body.  And  poffi- 
bly  forne  other  acrids  may  have  the  fame  effecl-j-. 

MXLI. 

Befide  thefe  moft  frequent  inftances  of  hematuria, 
which  cannot  be  coniidered  asidiopathic  hemorrhagies, 

F  2  v       there 

diluted  :  the  mucilaginous  drinks  are  abfolutely  necefTary,  and  ought 
to  be  ufed  plentiful!}^ 

*  The  only  method  of  treating  this  kind  of  hematuria  is  by  reft. 
A  perfon  fubjeft  to  it  ought  never  to  ride. 

f  This  fpecies  oWlematuria  is  cured  by  evacuating  the  acrid  fub- 
ftance,  and  by  the  ufe  of  the  mucilaginous  drinks  before  mentioned. 
The  acrid  fubftance  may  be  evacuated  by  antiphlo^ilac  purges,  or 
by  the  milder  diuretics,  as  nitre,  deco£lion  of  pariley  roots,  cream 
of  tartar  whey,  &c.  The  a&ion  of  cantharides  on  the  urinary  paf- 
fages is  not  well  explained.  We  can  fcarcdy  believe  th'it  any  part 
of  the  cantharides  is  abforbed  from  the  bliftering  plaiiter  ;  yet  its 
efFe&s  are  the  fame  with  thofe  produced  by  taking  the  canthai  ides 
niter/naljy.  The  ftrangury,  and  its  concomitant  fymptoms,  may  be 
relieved  by  large  and  plentiful  dilution,  and  a  free  ufe  of  the  rr.ucilagi- 
rous  drinks.  Camphor  has  been  thought  to  have  fome  fpecific  qua- 
lity in  preventing  and  curing  the  ftrangury  produced  by  bliilers,  and 
experience  warrants  the  conclufion  :  efpecially  if  the  camphor  isjoin- 
ed  with  opium  as  in  the  following  formula  : 
&.  Camphor,  gr.  vi. 

Spir.  vini  gutt.  x. 

Opii  puri  gr.  i. 

Conierv.  rofar,  5:. 

M.  f.  bolus. 


44  PRACTICE 

there  are  fome  other  inftances  of  hcmaturia  mentioned 
by  authors,  that  are  ftill  however  manifeflly  fymptoma- 
tic; fuch  asadifchargeofblcod  from  the  uri  nary  p  adag- 
es, in  co^fequenceof  a  fuppreifion  of  either  themcnfirual 
or  herfiorrhoidal  flux.  Thefe  may  be  coniidered  as 
analogous  to  the  hematemelis  produced  by  the  like 
caufes ;  and  thefeveral  reflections  made  above  on  that 
fubject,  will,  I  think,  apply  here,  and  particularly  the 
conclulions  formed  in  MXXIV.  Inftances,  however, 
of  either  of  thefe  cafes,  and  efpecially  of  the  firil,  have 
been  extremely  rare. 

MXLII. 

Of  fuch  fymptomatic  hcmaturia  there  is  however 
pne  inflance  deferving  notice ;  and  that  is,  when  a 
fuppreffion  of  the  hemorrhoidal  flux,  either  by  a  com- 
munication of  veiFels,  or  merely  by  thevicinity  of  parts, 
occafions  a  determination  of  the  blood  into  the  vef- 
fels  of  the  neck  of  the  bladder,  which  in  confequence 
of  a  rixis  or  anaftomofis,  pour  out  blood  to  be  voided 
either  with  or  without  the  urine.  This  cafe  is  what 
lias  been  named  the  Hemorrhoides  Veficae  ;  and  with 
fome  propriety,  when  it  is  manifeflly  an  evacuation 
vicarious  of  what  had  before  been  ufyally  made  from 
the  re&urn.  With  refpect  to  the  management  of  the 
hemorrhoides  veficae,  I  would  apply  the  whole  of  the 
d  '£tris>es  that  1  have  delivered  above,  with  refpcct  to 
the  cure  of  the  proper  hemorrhoidal  affection*. 
MX  LIU. 

There  remains  ftill  to  be  mentioned  one  other  in- 
rtance  of  fymptomatic  hematuria,  which  is  that  which, 
happens  in  the  cafe  of  confluent  and  putrid  fma!l-poxs 
us  well  as  in  feveral  other  inftances  of  putrid  dileaf- 
cs.  The  blood,  in  fuch  cafes,  may  be  pretumed  to 
come  from  the  kidneys;  and  1  apprehend  that  it  comes 
from  thence  in  confequence  of  that  fluidity  which,  is 
always  produced  in  the  blood  approaching  to  a  putrid 

flate 

*  Articles  947,  et  fequent. 


OF    P  H  Y  S  I  Q.  43 

Such  hematuria,  therefore,  is  not  to  be  confi- 
de td  as  a  fymptom  of  any  affection  of  the  kidneys, 
but  merely  as  a  mark  of  the  pturefcent  ftate  of  the 
fclood. 

MXLIV. 

In  certain  difeafes  the  urine  is  difcharged  of  fuch  a 
deep  red  c<  lour,  as  give  a  fufpicion  of  its  being  ting* 
ed  by  bloud  preientin  it;  and  this  has  given occalion 
to  Sauvages,  a*nongtt  the  other  fpecies  of  hematuria,  to 
mark  the  hematuria  fpuria,  and  the  hematuria  lateri- 
tia;  both  of  which,  however,  he  fuppofes  to  be  with- 
out any  blood  prefent  in  the  urine.  In  many  cafes  it 
is  of  importance,  in  aicertaining  the  nature  of  a  dif- 
ea£ •,  to  determine  whether  the  red  colour  of  urine  be 
from  blood  prefent  in  it,  or  from  a  certain  flate  of  the 
falts  and  oils  which  arc  always  in  greater  or  leffer  pro- 
portion ccnilituent  parts  of  the  urine  ;  and  the  quef- 
tion  may  be  commonly  determined  by  the  following 
^onfiderations. 

It  has  been  obferved  above,  that  when  any  confi- 
derable  quantity  of  blood  is  voided  with  the  urine, 
there  is  always  a  portion  of  it  depofitcd  at  the  bot- 
tom of  the  veffel  containing  the  voided  blood  and  u- 
rine ;  and  in  fuch  a  cafe  there  will  be  no  doubt  in  at- 
tributing the  colour  of  the  urine  floating  above,  to 
ibme  part  of  the  blood  diffufed  in  it.  The  quefh'on, 
therefore,  with  refpecl;  to  the  prefence  of  blood  in  the 
urine,  can  only  occur  when  no  fuch  dcpofition  as  I 
have  mentioned  appears ;  and  when  the  blood  that 
may  be  fuppofed  to  be  prefent  is  diflblved  or  diffufed, 
and  therefore  entirely  .fufpended  in  the  urine.  In  this 
cafe  the  prefence  of  the  blood  may  be  commonly 
known,  ill,  By  the  colour  which  blood  gives,  differ- 
ent from  any  urine  without  blood  that  I  have  ever 
feen ;  and  I  think  a  little  experience  will  enable  mbfl 
perfons  to  make  this  diflinclion.  2diy,  By  this,  that 
the  prefence  of  blood  always  dirnmifhes  the  tranfpa- 

rencv 


46  PRACTICE 

rency  of  ths  urine  with  which  it  is  mixed  :  and  it  is 
very  feldom  that  urine,  though  very  high-coloured, 
lofes  its  tranfparency ;  at  leaft  this  hardly  ever  ap- 
pears, if  the  urine  is  examined  when  recently  voided. 
3dly,  When  urine  has  blood  mixed  with  it,  it  tinges 
a  piece  of  linen  dipt  into  it  with  a  red  colour,  which 
the  higheft-coloured  urine  without  blood  never  does. 
4thly,  High-coloured  urine  without  blood,  upon  cool- 
ing, and  remaining  at  reft  in  a  veflel,  almoft  always 
depofites  a  lateritious  fediment ;  and  if  upon  any  oc- 
cafion  bloody  urine  fhould  depofite  a  fediment  that 
may  be  of  a. portion  of  the  blood  formerly  difFufed  in 
it,  the  difference,  however,  may  be  difcerned  by  this, 
that  the  fediment  depofited  by  urine  without  blood, 
upon  the  urine's  being  again  heated,  will  be  entirely 
re-diifoived,  which  will  not  happen  to  any  fediment 
from  blood.  Laftly,  we  know  no  flate  of  urine  with- 
out blood,  which  mews  any  portion  of  it  coagulable 
by  a  heat  equal  to  that  of  boiling-water  ;  but  blood 
difFufed  in  urine  is  Mill  coagulable  by  fuch  a  heat :  and 
by  this  teft,  therefore,  the  prefence  of  blood  in  urine 
may  be  commonly  afcertaincd. 


BOOK          V. 


OF  PROFLUVIA,    OR  FLUXES,    WITH 

PYREXIA. 
/ 

MXLV. 

FORMER  riofologifts  have  eftabliflied  a  clafs  of 
difeafes  under  the  title  of  Fluxes,  or  Profluvia  ; 
but  as  in  this  clafs  they  have  brought  together  a  great 
number  of  difeafes,  which  have  nothing  in  common^ 

excepting 


O  F    P  H  Y  S  I  C,  47 

excepting  the  fmgle  circumftaace  of  an  increafed  dif- 
charge  of  fluids,  and  which  alfo  are,  in  other  refpecls, 
very  different  from  one  another;  I  have  avoided  fo 
improper  an  arrangement,  and  have  diftributed  moil 
of  the  difeafes  comprehended  in  fuch  a  clafs  J?y  the 
nofoiogifts,  into  places  move  natural  and  proper  for 
them*.  I  have,  indeed,  flill  employed  here  the  gene- 
ral title ;  but  I  confine  it  to  fuch  fluxes  only  as  arc 
constantly  attended  with  pyrexia,  and  which  therefore 
neceflarily  belong  to  the  clafs  of  difeafes  of  which  I 
am  now  treating. 

Of  the  fluxes  which  maybe  confidered  as  being  ve- 
ry conftantly  febrile  difeafes,  there  are  only  two,  the 
catarrh  and  dyfentery  ;  and  of  thefe  therefore  1  now 
proceed  to  treat. 


CHAP.        I. 
OF    THE    CATARRH. 

MXLVL 

catarrh  is  an  increafed  excretion  of  mucus 
_    from  the  mucous  membrane  of  the  nofe,  fauces, 
and  bronchiae,  attended  with  pyrexia. 

Practical  writers  and  nofologiils  have  diftinguiilied 
the  difeafe  by  different  appellations,  according  as  ic 
happens  to  affect  thofe  different  parts  of  the  mucous 
membrane,  the  one  part  more  or  lefs  than  the  or  her  : 
But  I  am  of  opinion,  that  the  difeafe,  although  affecl- 


ing 


*  Sauvages  enumerates  no  lefs  than  thirty-fix  genera  of  fluxes, 
each  of  which  is  fubdivided  into  numerous  fpecies.  VogeLhas  for- 
ty-five genera,  under  the  title  of  profluviu,  mod  of  which  are  ex- 
tremely different  from  each  other  in  their  eflential  qnalitiec. 


48  PRACTICE 

ing  different  parts,  is  always  of  the  fame  nature,  and 
proceeds  from  the  fame  caufe.  Very  coirrnonly,  in- 
deed, thofe  different  parts  are  affecled  at  the  fame 
time  ;•  and  therefore  there  can  be  little  room  for  the 
difiin&ion  mentioned. 

The  difeafe  has  been  frequently  treated  of  under  the 
title  of  Tuflis,  or  Cough  ;  and  a  cough,  indeed,  always 
attends  the  chief  form  of  catarrh,  that  is,  the  increaf- 
ed  excretion  from  the  bronchia :  but  a  cough,  is  fo 
often  a  fymptom  of  many  other  afFedtions,  which  are 
very  different  from  one  another,  that  it  is  improperly 
employed  as  a  generic  title. 

MXLVII. 

The  remote  caufe  of  catarrh  is  mod  commonly  cold 
applied  to  the  body.  This  application  of  cold  pro- 
ducing catarrh,  can  in  many  cafes  be  diftinctly  ob- 
ferved ;  and  I  would  believe  it  always  to  be  fo,  were 
men  acquainted  with,  and  attended  to,  the  circum- 
ilances  which  determine  cold  to  a6t  upon  the  body. 
See  xciv — xcvi. 

From  the  fame  paragraphs  we  may  learn  what   in 
fome  perfons  gives  a  predifpofition  to  catarrh. 
MX  L  VIII. 

The  difeafe,  of  which  I  am  now  to  treat,  generally 
begins  with  fome  difficulty  of  breathing  through  the 
nofe,  and  with  a  fenfe  of  fome  fullnefs  (lopping  up 
that  paflage.  This  is  alfo  often  attended  with  fome 
dull  pain  and  a  fenfe  of  weight  in  the  forehead,  as  well 
as  fome  ftiffhefs  in  the  motion  of  the  eyes.  Thete  feel- 
ings, fometimes  at  their  very  firft  beginning,  and  al- 
ways foon  after,  are  attended  with  the  diftillation  from 
the  nofe  ;  and  fometimes  from  the  eyes,  of  a  thin  fluid, 
which  is  often  found  to  be  fomewhat  acrid,  both 
by  its  tafte,  and  by  its  fretting,  the  parts  over  which 
it  paifes. 

MXLIX. 

Thefe  fymptoms  confHtuce  the  cory-za  and  gnivccU 

of 


O  F    P  H  Y  S  I  C.  49 

of  medical  authors,  and  are  commonly  attended  with 
a  fenfe  of  laflitude  over  the  whole  body.  Sometimes 
cold  fhiverings  are  felt,  at  lead  the  body  is  more  fenfi- 
ble  than  ufual  to  the  coldnefs  of  the  air ;  and  with  all 
this  the  pulfe  becomes,  efpecially  in  the  evenings,, 
more  frequent  than  ordinary. 

ML. 

'  Thefe  fymptoms  feldom  continue  long  before  they 
are  accompanied  with  fome  hoarfenefs,  and  a  fenfe  of 
roughnefs  and  forenefs  in  the  trachea,  and  with  fome 
difficulty  of  breathing,  attributed  to  a  fenfe  of  (trait- 
nefs  of  the  cheft,  and  attended  with  a  cough,  which 
feems  to  arife  from  fome  irritation  felt  at  the  glottis. 
The  cough  is  generally  at  firfl  dry,  cccafioning  pains 
about  the  cheft,  and  more  efpecialiy  in  the  bieaih 
Sometimes,  together  with  thefe  fyn  ptoms,  pains  re- 
fembling  thofe  of  the  rheumatifm  arc  felt  in  feveral 
parts  of  the  body,  particularly  about  the  neck  and 
Jiead.  While  thefe  fymptoms  take  place,  the  appe- 
tite is  impaired,  fome  third  arifes,  and  a  general  lafli- 
tude is  felt  over  all  the  body. 

MLL 

Thefe  fymptoms  (MXLVIII — ML.)  mark  the  violence 
and  height  of  the  difeafe  ;  which,  however,  does  not 
commonly  continue  long.  By  degrees  the.  cough  be- 
comes attended  with  a  copious  excretion  of  mucus  ; 
which  is  at  firft  thin,  but  gradually  becoming  thicker, 
is  brought  up  with  lefs  frequent  and  lefs  laborious 
Coughing.  The  hoarfenefs  and  forenefs  of  the  tra- 
chea, Hkewife  going  off,  the  febrile  fymptoms  abating, 
the  cough  becoming  lefs  frequent,  and  with  lefs  ex- 
pectoration, the  difeafe  foon  after  ceafes  altogether. 

MLII. 

Such  is  generally  the  courfe  of  this  difeafe,  which  is 
commonly  neither  tedious  nor  dangerous;  but,  upon 
fome  occafions,  it  is  in  both  refpects  otherwise.  A 
perfon  affected  with  catarrh  feems  to  be  more  than  u- 

VOL.  II.  G  fually 


50  PRACTICE 

fually  liable  to  be  affe&ed  by  cold  air  ;  and  in  that 
condition,  if  expofed  to  cold,  the  difeafe,  which  feem-: 
ed  to  be  yielding,  is  often  brought  back  with  greater 
violence  than  before  :  and  is  rendered  not  only  more 
tedious  than  otherwife  it  wotdd  have  been,  but  alfo 
more  dangerous  by  the  fupervening  of  other  difeafes. 

MLIII. 

Some  degree  of  the  cynanche  tonlillaris  often  ac- 
companies the  catarrh ;  and  when  the  latter  is  aggra- 
vated by  a  freili  application  of  cold,  the  cynanche  al- 
fo becomes  more  violent  and  dangerous,  in  confe- 
quence  of  the  cough  which  is  prefent  at  the  iame 
time. 

JMLIV. 

When  a  catarrh  has  been  occafioned  by  a  violent 
caufe  ;  when  it  has  been  aggravated  by  improper  ma- 
nagement ;  and  efpecially  when  it  has  been  render- 
ed more  violent  by  freili  and  repeated  applications  of 
cold,  it  often  pailcs  into  a  pneumonic  inflammation 
attended  with  the  utmofl  danger. 

MLV. 

Unlefs,  however,  fuch  accidents  as  thofe  of  MLII— 
MLIV.  happen,  a  catarrh,  in  fotind  perfons  not  far 
advanced  in  life,  is,  I  think,  always  a  flight  difeafe, 
and  attended  with  little  danger.  But,  in  perfons  of  a 
phthiiical  difpofitton,  a  catarrh  may  readily  produce 
a  hemoptyfis,  or  perhaps  form  tubercles  in  the  lungs ; 
and  more  certainly,  in  perfons  who  have  tubercles  al- 
ready in  the  lungs,  an  accidental  catarrh  may  occa- 
fionthe.inflammation  of  thefe  tubercles,  and  in  confe- 
quence  produce  a  phthiiis  pulmonalis. 

MLVI. 

In  elderly  perfons,  a  catarrh-  fornetimes  proves  a 
dangerous  difeafe.  Many  perfons,  as  they  advance 
in  lire,  and  efpecially  after  they  arrive  at  old  age, 
have  the  natural  mucus  of  the  lungs  poured  out  in 
greater  quantity,  and  confequently  requiring  a  fre- 
quent 


OF     PHYSIC.  51 

quent  expectoration.  If  therefore  a  catarrh  happen 
to  fueh  perfons,  and  increafe  the  afflux  of  fluids  to 
the  lungs,  with  fome  degree  of  inflammation,  it  may 
produce  the  pcripneumonia  notha,  which  in  fuch  caf- 
es is  very  often  fatal,  See  CCCLXXVI — CCCLXXXU. 

MLVII. 

The  proximate  caufe  of  catarrh  feems  to  be  an  in- 
creafed  afflux  of  fluids  to  the  mucous  membrane  of 
the  riofe,  fauces,  and  bronchia^  along  with  fome  de- 
gree of  inflammation  affecling  thefe  parts .  The  lat- 
ter circumftance  is  confirmed  by  this,  that  in  the  cafe 
of  catarrh,  the  blood  drawn  from  a  vein,  commonly 
exhibits  the  fame  inflammatory  crufl  which  appears  in 
the  cafe  of  phlegmafiae. 

MLVIII. 

The  application  of  cold  wiieh  occafions  a  catarrh, 
probably  operates  by  diminiming  the  perfpiration  ufu- 
ally  made  by  the  fkin,  atid  which  is  therefore  deter- 
mined to  the  mucous  membrane  of  the  parts  above 
mentioned.  As  a  part  of  the  weight  which  the  body 
daily  loies  by  infenfible  evacuation,  is  owing  to  an  ex- 
halation from  the  lungs,  there -is  probably  a  connec- 
tion between  this  exhalation  and  the  cutaneous  per- 
fpiration, fo  that  the  one  may  be  increafed  in  p&por- 
tion  as  the  other  is  diminifried  :  and  therefore  we 
may  underfland  how  the  diminution  of  cutaneous  per- 
fpiration,  in  confequence  of  the  application  of  cold, 
may  increafe  the  afflux  of  fluids  to  the  lungs,  and, 
thereby  produce  a  catarrh. 

ML  IX. 

There  are  fome  obfervations  made  by  Dr.  James. 
Keil  which  may  feem  to  render  this  matter  doubtful  ; 
but  there  is  a  fallacy  in  his  obfervations.  The  evident 
effects  of  cold  in  producing  coryza,  leave  the  matter 
in  general  without  doubt;  and  there  are  feveral  other 
circumftances  which  (how  a  connexion  between  the 
lungs  and  the  furface  of  the  body. 

G  2  'MLX. 


$z  PRACTICE 

MLX. 

Whether,  from  the  fuppreflion  of  perfpiration,  a 
catarrh  be  produced  merely  by  an  increafed  afflux  of 
fluids,  or  whether  the  matter  of  perfpiration  be  at  the 
fame  time  determined  to  the  mucous  glands,  and  there 
excite  a  particular  irritation,  maybe  uncertain;  but 
the  latter  fuppofition  is  fufficiently  probable. 

MLXI. 

Although,  in  the  cafe  of  a  common  catarrh, 
which  is  in  many  inftances  fporadic,  it  may  be  doubt- 
ful whether  any  morbific  matter  be  applied  to  the  mu- 
cous glands  ;  it  is,  however,  certain,  that  the  fymp- 
toms  of  a  catarrh  do  frequently  depend  upon  fuch  a 
matter  being  applied  to  thefe  glands;  as  appears  from 
the  cafe  of  the  meafles,  chin-cough,  and  efpecially 
from  the  frequent  occurrence  of  contagious  and  epide* 
mical  catarrh. 

MLXII. 

The  mention  of  this  laft  leads  me  to  obferve,  that 
there  are  two  fpecies  of  catarrh,  as  I  have  marked  in 
my  Synopiis  of  Nofology.  One  of  thefe,  as  I  fuppofe, 
is  produced  by  cold  alone,  as  has  been  explained  above  ; 
and  the  other  feems  manifellly  to  be  produced  by  a 
fpeciic  contagion. 

Of  fuch  contagious  catarrhs*,  I  have  pointed  out  in 
the  Synopfis  many  inftances  occurring  from  the  14th 
century  down  to  the  prefent  day.  In  ail  thefe  in- 
ftances the  phenomena  have  been  much  the  fame ; 
and  the  difeafe  has  always  been  particularly  remarka- 
ble in  this,  that  it  has  been  the  mod  widely  and  ge- 
nerally fpreading  epidemic  known.  It  has  ieldom  ap- 
peared  in  any  one  country  of  Europe,  without  appear- 
ing fucceflively  in  every  other  part  of  it ;  and  in  fome 
inftances,  it  has  been  even  transferred  to  America,  and 

has 

*  Thefe  epidemical  catarrhs  have  been  lately  termed  Influenzas. 


O  F     P  H  Y  S  1  C.  5.3 

has  been  fpread  over  that  continent,  fo  far  as  we  have 
had  opportunities  of  being  informed. 
MLXIII. 

The  catarrh  from  contagion  appears  with  nearly 
the  famefyniptoms  asthofe  mentioned  MXLVIII. — ML. 
It  feems  often  to  come  on  in  confequence  of  the  ap- 
plication of  cold.  It  comes  on  with  more  cold  fhiver- 
Ing  than  the  catarrh  ariling  from  cold  alone,  and  foon- 
cr  mows  febrile  fymptoms,  and  thefc  likewife  in  a 
more  confiderable  degree.  Accordingly,  it  more  fpee- 
dily  runs  its  courfe,  which  is  commonly  iinimed  in  a 
few  da}  s.  It  fometimes  terminates  by  a  fpontaneous 
fweat ;  and  this,  in  fome  perfons,  produces  a  miliary 
eruption.  It  is,  however,  the  febrile  ftate  of  this  dif- 
eafe  efpecially,  that  is  finiHied  in  a  few  days  :  for  the 
cough,  and  other  catarrhal  fysnptoms,  do  frequently 
continue  longer  ;  and  often,  when  they  appear  to  be 
going  off,  they  are  Renewed  by  a.ny  frefh  application 
©f  cold. 

MLXIV. 

Confidering  the  number  of  perfons  who  arc  affected 
with  catarrh,  of  either  the  one  fpecies  or  the  other, 
and  efcape  from  it  quickly  without  any  hurt,  it  may 
be  allowed  to  be  a  difeafe  very  free  from  danger;  but 
St  is  not  always  to  be  confidered  as  fuch  ;  for  in  fomc 
perfons  it  is  accompanied  with  pneumonic  inflamma- 
tion. In  the  phthiiically  difpofed,  it  often  accele- 
rates the  coming  on  of  phthifis  ;  and  in  elderly  per- 
fons, it  frequently  proves  fatal  in  the  manner  explain- 
ed above,  MLIV.  and  MLVI. 

MLXV. 

The  cure  of  catarrh  is  nearly  the  fame,  whether  it 
proceed  from  cold  or  contagion ;  with  this  difference, 
that  in  the  latter  cafe,  remedies  are  commonly  more 
neceffary  than  in  the  former. 

In  the  cafes  of  a  moderate  difeafe,  it  is  commonly 
Sufficient  to  avoid  cold,  and  to  abftain  from  animal 

food 


54  PRACTICE 

food  for  fomedays*  ;  or  perhaps  to  lie  a-be-d,  and  by 
taking  frequently  of  fome  mild  and  diluent  drink,  a 
little  warmed,  to  promote  a  very  gentle  fweat ;  and 
after  thefe  to  take  care  to  return  very  gradually  only, 
to  the  ufe  of  the  free  air. 

MLXVI. 

When  the  dMeafe  is  more  violent,  not  only  the  anti- 
phlogiftic  regimen  mufl  be  exactly  obferved,  but  va- 
rious remedies  alfo  become  neceiTary. 

To  take  off  the  phlogiftic  diatheiis  which  always  at- 
tends this  difeafe,  blood-letting,  in*  a  larger  orfmaller 
quantity,  and  repeated  according  as  the  fymptoms  fhall 
require,  is  th«ftproper  remedy. 

For  reftoring  the  determination  of  the  fluids  to  the 
furfuce  of  the  body§,  and  at  the  fame  time  for  cxpe- 
ding  the  fecretion  of  mucus  in  the  lungs,  which  may 
take  off  the  inflammation  of  its  membrane,  vomiting 
is  the  mod  effectual  means. 

.  For  the  latter  purpofe,  it  has  been  fuppofed,   that 

fquills, 

*  Perhaps  an  abftinence  from  all  food  would  accelerate  the  cure  : 
The  mucilaginous  drinks  ought  to  be  taken  in  considerable  quanti- 
ties, and  they  are  fomewhat  nutritive. 

§  The  means  of  producing  a  gentle  and  continued  perspiration 
have  been  mentioned  in  a  former  note.  In  catarrh,  however,  the 
yfe  of  the  warmer  fudorifics  leems  more  effectual.  The  elixir  pare- 
goricum,  diluted  with  whey,  efpecially  whey  made  with  the  dulcified 
ipirit  of  nitre,  is  of  fmgular  ufe  ;  but  it  ought  not  to  be  given  if  there 
is  a  conCderable  degree  of  phlogiftic  diathefis.  In  this  cafe  a  fpoon- 
ful  of  the  following  folution  may  be  t?iven  every  two  or  three  hour?, 
till  a  fweat  breaks  out  : 

§,.  Tart.  emet.  gr.  ii. 

Aq.  font.  5\'i. 

Syr.  Althaeie  ?ii. 

M. 

It  will  be  necefTary  for  the  patient  to  chew  cccafionally  fome  muci- 
laginous demulcent,  as  Extract  of  Liquorice,  Sec.  or  to  take  a  tca- 
(poonful  of  equal  parts  of  oil  and  honey,  in  order  to  prevent  the  (harp 
matter  from  irritating  the  fauces.  The  Elect,  pectorale  of  the" 


O  F    P  H  Y  S  I  a  55 

fquills,  gum  ammoniac*,  the  volatile  alkali,  and  fome 
other  medicines,  might  be  ufeful  :  but  their  efficacy 
has  never  appeared  to  me  to  be  coniiderable  ;  and,  if 
fquills  have  ever  been  very  ufeful,  it  feems  to  have 
been  rather  by  their  emetic,  than  by  their  expecto- 
rant powers. 

When  the  inflammatory  afFe&ions  of  the  lungs 
feem  to  be  considerable,  it  is  proper,  be  fides  blood- 
letting, to  apply  bliilers  on  fome  part  of  the  thorax. 

As  a  cough  is  often  the  moil  troublefome  circum- 
fiance  of  this  difeafe,  fo  demulcents  may  be  employed 
to  alleviate  it.  See  CCCLXXIII. 

But  afrer  the  inflammatory  fymptoms  have  much  a- 
bated,  if  the^ough  ihould  ftill  continue,  opiates  af- 
ford the  moil  effectual  means  of  relieving  it;  and  in 
the  circumilances  juft  now  mentioned,  they  may  be 
very  fafely  employed.  Sec  CCCLXXV. 

After  the  inflammatory  and  febrile  flates  of  this 
difeafe  are  almoil  entirely  gone,  the  moil  effe&ual 
means  of  difcuffing  all  remains  of  the  catarrhal  af- 
fe&ion,  is  by  fome  exercife  of  geflation  diligently  em- 
ployed. 

CHAP. 

Edinburgh  Pharmacopoeia  not  only  relieves  the  tickling,  but  tends 
to  produce  a  falutary  diaphorefis ;  its  dofe  is  the  fize  of  a  nutmeg 
three  or  four  times  a-day. 

*  The  ammoniac  and  fquiiJs  may  be  joined  together  in  the  fol- 
lowing form  : 

$,.  Lac  ammoniac,  giv. 
Syr.  Scillit.  £iii. 
M. 

This  mixture  mud  be  acknowledged  to  be  fomewhat  naufeou*, 
biit  it  has  confiderable  efficacy.  The  dofe  of  it  is  two,  or  (if  the 
itomach  can  bear  it)  three  table fpoor.fuls  twice  a-da 


5«  PRACTICE 

CHAP.       II. 
OF  THE  DYSENTERY. 

MLXVII. 

THE  dyfentery  is  a  difeafein  which  the  patient  has 
frequent  (tools  accompanied  with  much  griping, 
and  followed  by  a  tenefmus.  The  ftools,  ihough  fre- 
quent, are  generally  in  fmall  quantity  ;  and.  the  mat- 
ter voided  is  chiefly  mucus,  ibmetimes  mixed  with 
blood.  At  the  fame  time  the  natural  feces  feldom  ap- 
pear, and,  when  they  do,  it  is  generally  in  a  compact 
and  hardened  form. 

MLXVIII. 

This  difeafe  occurs  efpecially  infummer  and  autumn? 
at  the  fame  time  with  autumnal  intermittent  and 
remittent  fevers ;  and  with  thefe  it  is  fometimes  com- 
bined or  complicated*. 

MLXIX. 

The  difeafe  comes  on  fotnetimes  with  cold  fhiver- 
ings,  and  other  fymptoms  or  pyrexia;  but  more  com- 
monly the  fymptoms  of  the  topical  affection  appear 
firft.  The  belly  is  coftive.  with  an  unufual  flatulence 
in  the  bowels.  Sometimes,  though  more  rarely,  fome 
degree  of  diarrhoea  is  the  firft  appearance.  In  mod 
cafes  the  difeafe  begins  with  griping,  and  a  frequent 
inclination  to  go  to^ftool.  In  indulging  this,  little  is 
voided ;  but  fome  tenefmus  attends  it.  By  degrees, 
the  ftools  becomes  more  frequent,  the  griping  more 
fevere,  and  the  tenefmus  more  confiderable.  Along 
with  thefe  fymptoms  there  is  a  lofs  of  appetite  ;  and 
frequently  ficlcnefs,  naufea,  and  vomiting,  alfo  affect- 
ing the  patient.  At  the  fame  time  there  is  always 
more  or  lefs  of  pyrexia  prefent,  which  is  fometimes  of 

the 

*  It  appears  more  efpecially  In  armies  encamped  In  low  fwampy 
§rouiids»»rid,  without  proper  management.,  is  highly  deftru&ive. 


O  F    P  H  Y  S  I  C.  57 

ihe  remittent  kind,  and  obferves  a  tertian  period. — . 
Sometimes  the  fever  is  manifeftly  imflammatory,  and 
very  often  of  a  putrid  kind.  Thefe  febrile  itates  con- 
tinue to  accompany  the  difeafe  dining  its  whole 
courfe,  efpeciully  when  it  terminates  foon  in  a  fatal 
manner.  In  other  cafes,  the  febrile  ftate  almofl  en- 
tirely difappears,  while  the  proper  dyfenteric  fymp- 
toms  remain  for  a  long  time  after. 

MLXX. 

In  the  courfe  of  the  difeafe,  whether  of  fhorter  or* 
longer  duration,  the  matter  voided  by  ftool  is  very  va- 
rious. Sometimes  it  is  merely  a  mucous  matter, 
without  any  blood  exhibiting  that  difeafe  which  J)r. 
Roderer  has  named  the  morbus  mucofus,  and  others 
the  dyfenteria  alba.  For  the  moft  part,  however,  the 
mucus  discharged  is  more  or  lefs  mixed  with  blood. 
This  fome times  appears  only  in  ftreaks  amongft  the 
mucus ;  but  at  other  times  is  more  copious,  tinging 
the  whole  of  the  matter  discharged;  and  upon  fome 
occaiions  a  pure  arid  unmixed  blood  is  voided  in  con- 
iiderable  quantity.  In  other  refpeds,  the  matter 
voided  is  varioufly  changed  in  colour  and  conlillence, 
and  is  commonly  of  a  ftrong  and  unufually  fetid  odour^ 
It  is  probable,  that  fometimes  a  genuine  pus  is  voided; 
and  frequently  a  putrid  fanies,  proceeding  from  gan- 
grenous parts.  There  are  very  often  mixed  with  the 
liquid  matter  fome  films  of  a  membranous  appearance, 
and  frequently  fome  finall  maffes  of  a  feemingly  feba- 
ceous  mutter. 

MLXXI. 

While  the  flools  confuting  of  thefe  various  matters 
are  in  many  inftances,  exceedingly  frequent,  it  is  fe1- 
dom  that  natural  faeces  appear  in  them ;  and  when 
they  do  appear,  it  is,  as  I  have  mentioned,  in  'he 
form  of  fcybala,  that  is,  in  fomewhat  hardened,  ft- pa- 
rate  balls.  When  thefe  are  voided,  whether  by  the 
efforts  of  nature,  or  as  Solicited  by  art,  they  proem  e 

H  a  lemif- 


58  PRACTICE 

a  reniilfion  of  all   the   fymptoms,    and   more  efpeci- 
ally  of  the  frequent  {tools,  griping,  and  tcnefnius. 

MLXXII. 

Accompanied  with  thefe  circumftances,  the  difeafe 
proceeds  for  a  longer  or  a  fhorter  time.  When  the 
pyrexia  attending  it  is  of  a  violent  inflammatory  kind, 
and  more  efpecially  when  it  is  of  a  very  putrid  nature, 
the  difeafe  often  terminates  fatally  in  a  very  few  days, 
with  all  the  marks  of  a  fupervening  gangrene.  When 
the  febrile  ilate  is  more  moderate,  or  difappears  alto- 
gether, the  difeafe  is  often  protracted  for  weeks,  and 
even  for  months;  but  even  then,  after  a  various  dura- 
tion, it  often  terminates  fatally,  and  generally  in  con- 
iequence  of  a  retuin  and  conikierable  aggravation  of 
the  inflammatory  and  putrid  dates.  In  fome  cafes, 
the  difeafe  ceafes  fpoiitaneouily  ;  the  frequency  of 
(tools,  the  griping,  and  tenefmus,  gradually  diminifh- 
es,  while  natural  (tools  return.  In  other  cafes,  the 
difeafe,  with  moderate  fymptoms,  continues  long,  and 
ends  in  a  diarrhoea,  fometimes  accompanied  with  li- 
cnteric  fymptoms. 

MLXXIII. 

The  remote  caufes  of  this  difeafe  have  been  vari- 
oully  judged  of.  It  generally  aiifcs  in  fummer  or  au- 
tumn, after  confiderabie  heats  have  prevailed  for  fome 
time,  and  efpecially  after  very  warm,  and  at  the  fame 
time,  very  dry  dates  of  the  weather  ;  and  the  difeafe 
is  more  frequent  in  warm,  than  in  cooler  climates. — 
It  happens,  therefore,  in  the  fame  circumltances  and 
feafons  which  coniiderably  affecl  the  (tate  of  the  bile 
in  the  human  body  ;  but  us  the  cholera  is  often  with- 
out any  dyicnteric  (ymptoms,  and  copious  diicharges 
of  bile  have  been  found  to  relieve  the  iymptorns  of  dy- 
lt-ntery,  it  is  difficult  to  determine  what  connection 
the  difeafe  has  with  the  (tate  of  the  bile. 

MLXX1V. 

It  has  been  obferved,  that  the  effluvia  from  very  pu- 
trid 


O  F    P  H.  Y  S  I  C.  59 

tiid  animal  fubftances,  readily  affecl  the  alimentary 
canal  ;  and  upon  fome  occafions  they  certainly  pro- 
duce a  diarrhoea  ;  but,  whether  they  ever  produce  a 
genuine  dyfentery,  I  have  not  been  able  to  learn  with 
certainty. 

MLXXV. 

The  dyfcntery  does  often  manifeflly  arife  from  the 
application  of  cold,  but  the  difcafe  is  .always  contagi- 
ous; and  by  the  propagation  of  fuch  contagion,  inde- 
pendent of  cold,  or  other  exciting  caufes,  it  becomes 
epidemic  in  camps  and  other  places.  It  is,  therefore, 
to.  be  doubted,  if  the  application  of  cold  does  ever 
produce  the  difeafe,  unlcfs  where  the  fpecific  contagi- 
on has  been  prcviouily  received  into  the  body  :  And 
upon  the  whole,  it  is  probable,  that  a  fpeciiic  contagi- 
on is  to  be  confidered  as  always  the  remote  caufe  of 
this  difeafe. 

MLXXVI. 

Whether  this  contagion,  like  many  others,  be  of  a 
permanent  nature,  and  only  (hows  its  effects  in  certain 
circumftances  which  render  it  active,  or  if  it  be  occa- 
lionally  produced,  I  cannot  determine.  Neither,  if 
the  latter  fuppofkion  be  received,  can  I  fay  by  what 
means  it  may  be  generated.  As  little  do  we  know  any 
thing  of  its  nature,  confidered  in  hfelf  9  or  at  moil  this 
only,  that  in  common  with  many  other  contagions,  it 
appears  to  be  commonly  of  a  putrid  nature,  and  capa- 
ble of  inducing  a  putrefcent  tendency  in  the  human 
body.  This,  however,  does  not  at  all  explain  its  pecu- 
liar power  in  inducing  thofe  fymptoms  which  proper- 
ly and  effentially  coniiitute  the  difeafe  of  dyfentery. 
(MLXVII.) 

MLXXV1I. 

Of  thefe  fymptoms  the  proximate  caufe  is  ft  ill  ob~ 
fctire.  The  common  opinion  has  been,  that  the  dif- 
cafe depends  upon  a-n  acrid  matter  received  into,  or 
generated  in,  the  inteflines  themfelvcs  exciting  their 

H  2  perif- 


6®  .      PRACTICE 

periftaltic  motion,  and  thereby  producing  the  frequent 
ftools  which  occur  in  this  difeate.      But  this  fuppbii- 
tion  cannot  be   admitted  :  for,    in    all  the  inftances 
known  of  acrid   fubftances  applied  to  the  inteftines 
and  producing  frequent  ftools,   they  at  the  fame  time 
produce  copious  ftools,   as  might  be   expected  from 
acrid  fubftances  applied  to  any  length  of  the  inteftines. 
This,  however,  is  not  the  cafe  in  dyfentery  ;  in  which 
the  ftools,   however  frequent,  are   generally   in  very 
fmall  quantity,  and  fuch  as  maybe  fuppofed   to  pro- 
ceed from  the  lower  parts  of  the  rectum  only.     With 
refpecl  to  the  fuperior  portions  of  the  inteftines,  and 
particularly  thofe  of  the  colon,  it  is  probable  they  are 
under  a  preternatural  and  coniiderable  degree  of  con- 
ftriclion :  For  as  I  have  obfcrved  above,   the  natural 
fseces  are  feldom  voided  ;  and  when  they  are,  it  is  in 
n,  form  which  gives  reafon  to  fuppofe,  they  have  been 
long  retained  in  the  cells  of  the  colon,  and  confequent- 
ly  that  the  colon  had  been  affected  with  a  preternatu- 
ral conftriclion.     This  is  confirmed  by  aimed  all  the 
directions  which  have  been  made  of  the  bodies  of  dy- 
fenre.'ic  patients,    in  which,  when   gangrene  had  not 
extirely  deftroyed  the    texture  and  form  of  the  pans, 
considerable   portions   of  the    great    guts  have  been 
found  affected  with  a  very  considerable  conftriclion. 

MLXXVIII. 

I  apprehend,  therefore,  that  the  proximate  caufe  of 
dyfentery,  or  at  leaft  the  chief  part  of  the  proximate 
cauie,  confifts  in  a  preternatural  conftriction  of  theco- 
Ion,  occafioning  at  the  fame  time  thofe  fpafmodic  ef- 
forts which  are  felt  in  fevere  gripings ;  and  which 
efforts,  propagated  downwards  to  the  rectum,  occaiion 
there  the  frequent  mucous  ftools  and  tenefmus,. — 
But,  whether  this  explanation  Ihall  be  admitted  or 
not,  it  will  ftill  remain  certain,  that  hardened  fasces  re- 
tained in  the  colon  are  the  caufe  of  the  giiping,  fre- 
quent ftools  and  tenefmus  :for  the  evacuation  of  thefe 


OF      PHYSIC.  61 

Faeces,  whether  by  nature  or  by  art,  gives  relief  from 
the  fymptoms  mentioned;  and  it  will  be  more  fully 
and  ufefully  confirmed  by  this,  that  the  moil  immedi- 
ate and  fuccefsful  cure  of  dyfentery,  is  obtained  by 
an  early  and  conilant  attention  to  the  preventing  the 
conilriction,  and  the  frequent  ftagnation  of  faeces  in 
the  colon. 

MLXXIX. 

In  this  manner  I  have  endeavoured  to  afcertain  the 
proximate  caufe  of  dyfentery,  and  therefore  to  point 
out  aifo  the  principal  part  of  the  cure,  which  from 
want  of  the  proper  view  of  the  nature  of  the  difeafe, 
feems  to  have  been  in  feveral  refpects  fluctuating  and 
undetermined  among  practitioners. 

;  MLXXX. 

The  moft  eminent  of  our  late  practitioners,  and  of 
greatefl  experience  in  this  difeafe,  feem  to  be  of  opi- 
nion, that  the  difeafe  is  to  be  cured  moil  effectually 
by  purging  affiduoufly  employed.  The  means  may 
be  various ;  but  the  moil  gentle  laxatives  are  ufually 
fufficient,  and  as  they  mud  be  frequently  repeated, 
the  moil  gentle  ate  the  moil  fafe  ;  the  more  efpecially 
as  an  inflammatory  ilate  fo  frequently  accompanies 
the  difeafe.  Whatever  laxatives  produce  an  evacua- 
tion of  natural  fasces,  and  a  confequent  remiffion  of 
the  fymptcms,  will  be  furncient  to  effectuate  the  cure. 
But  if  gentle  laxatives  mall  not  produce  the  evacua- 
tion now  mentioned,  feme  more  powerful  medicines 
muit  be  employed*  :  and  I  have  found  nothing  more 

proper 

*  I  flrall  fubjoin  fome  formulas  fuitable  for  procuring  a  paflagf 
in  the  dyfentery. 

£>.  Infuf.  fenn,  gii. 
Mannas  opt,  51. 
M.  f.  hautt. 
&.  Maiinae  gi. 

Sal.  Glauber  gfs. 

Solve  in  aq.  bullient.  giii.  et  adde 

Tindl,  Cardamomi  31. 


62  PRACTICE 

proper  or  convenient  than  tartar  .emetic,  given  in 
Imall  dofes,  and  at  fuch  intervals  as  may  determine 
their  operation  to  be  chiefly  by  itool.  Rhubarb,  fo 
frequently  employed,  is  in  feveral  refpccls  amongft 
the  moil  improper  purgatives. 

MLXXXL 

Vomiting  has  been  held  a  principal  remedy  in  this 
difeafe ;  and  may  be  ufefully  employed  in  the  begin- 
ning of  it,  with  a  view  to  both  the  Hate  of  the  flomach 
and  of  the  fever  :  but  it  is  not  neceflary  to  repeat  it 
often  ;  and  unlefs  the  emetics  employed  operate  alfo 
by  ftool,  they  are  of  little  fervice.  Ipecacuanha  feems 
to  poiTefs  no  fpecific  power  :  and  it  proves  only  ufeful 
when  fo  managed  as  to  operate  chiefly  by  flool. 
MLXXXII. 

For  relieving  the  conftriction  of  the  colon,  and  e- 
vacuating  the  retained  fasces**,  glyfters  may  fometimes 
be  ufeful :  but  they  arc  feldom  fo  effectual  as  laxatives 
given  by  the  mouth  ;  and  acrid  glyfters,  if  they  be  not 
effectual  in  evacuating  the  colon,  may  prove  hurtful 
by  ftimulating  the  rectum  too  much. 
MLXXXIU. 

The  frequent  and  fevere  griping  attending  this  dif- 
eafe, leads  almoft  neceffarily  to  the  ufe  of  opiates,  and 
they  are  very  effectual  for  the  purpofe  of  relieving  from 
the  gripes;  but  by  occafioning  an  interruption  of  the  ac- 
tion 

Where  ftronger  purgatives  arc  requifite, 
£>.  Refin.  Jalap,  gr.  x.  vel.  xv. 

Tere  in  mortario  marmoreo,  cum 
Armygdal.  dale*  decort.  No.  iii. 
Sach.  alb. '31. 
Dein  adde 

Aq,  cinnamom.  fimpl.  ^ifs. 
M. 

*  Clyfters  in  thefe  cafes  ought  to  be  made  very  large,  and  they 
ought  alfo  to  be  very  mild  ;  as  a  pint  and  an  half,  or  even  two  pints, 
of  thin  lintfeed-tea,  or  decodion  ofmarflvmallows,  without  any  o- 
ther  addition. 


OF     PHYSIC.  <% 

tion  of  the  fmall  guts,  they  favour  the  con  Uriel  ion  of 
the  colon,  and^thereby  fometimes  aggravate  the  dif- 
eafe.:  and  if  at  the  fame  time  the  ufe  of  them  fuperfede 
in  any  meufure  the  employing  of  purgatives,  it  com- 
monly does  much  mifchief ;  I  believe  it  indeed  to  be 
only  the  negledl  of  purging,  that  renders  the  ufe  of 
opiates  very  neceflary*. 

MLXXXIV. 

When  the  gripes  are  both  frequent  and  fevere,  they 
may  fometimes  be  relieved  by  the  employment  of  a 
femicupium,  or  by  a  fomentation  of  the  abdomen, 
continued  forfome  time.  In  the  fame  cafe,  the  pains 
may  be  relieved,  and,  as  I  think,  the  conftriction  of 
the  colon  may  be  taken  off,  by  bliiters  applied  to  the 
lower  bellyj-. 

MLXXXV. 

At  the  beginning  of  this  difeafe,  when  the  fever  is 
any  way  considerable,  blood-letting,  in  patients  of  to- 
lerable vigour,  may  be  proper  and  neceflary  ;  'and, 
when  the  pulfe  is  full  and  hard,  with  other  fymptoms 
of  an  inflammatory  difpofition,  blood-letting  ought 
to  be  repeated.  But,  as  the  fever  attending  dyfente- 
ry  is  often  of  a  putrid  kind>  or  does,  in  the  courfe  of 

the 

*  The  griping  is  much  relieved,  and  fometimes  prevented,  by 
drinking  plentifully  of  any  mucilaginous  warm  Jiquois  during  the 
operation  of  the  purges ;  as  barley-water,  with  bruited  prunes  boil- 
ed in  it*. 

f  Bliilers  applied  to  the  abdomen,  befides  being  cv;c'  fn\v!y  trou- 
blcfome,  muft  necefiarily  be  extremely  painful.  Practitioners  have 
probably  been  deceived  in  thinking  that  blifters  have  relieved  griping 
in  the  dyfentery,  for  they  are  feldom  employed  alone  ;  and  the  effects 
of  purges  and  diluents  have  perhaps  been  miftaken  for  the  effects  of 
a  blifter  that  might  have  happened  to  have  been  applied  at  the  time 
when  thefe  other  remedies  were  ultd.  Too  itridt  an  attmtion  to  t)ic 
falfe  axiom,  poll  hoc  ergo  propter  hoc,  has  been  the  fourcc  of  nu- 
merous errors  in  the  practice  of  phyfic,  and  has  rai'fcd  the  reputa- 
tion of  the  phyfichui  and  his  remedies,  when  the  mciit  was  only 
due  to  nature. 


64  PRACTICE 

the  difeafe,  become  foon  of  that  nature,  blood-letting 
muft  be  employed  with  great  caution. 
MLXXXVI. 

From  the  account  now  given  of  the  nature  of  this 
difeafe,  it  will  be  fufficiently  obvious,  that  the  ufe  of 
aftringents  in  the  beginning  of  it  mull  be  abfolutely 
pernicious. 

MLXXXVII. 

Whether  an  acrid  matter  be  the  original  caufe  of 
this  difeafe,  may  be  uncertain :  but  from  the  indigef- 
tion  and  the  ftagnation  of  fluids  in  the  ilomach  which 
attend  the  difeafe,  it  maybe  prefumcd,  that  fome acrid 
matters  are  conftantly  prefentin  theitomach  and  intef- 
tines,  and  therefore  that  demulcents  may  be  always 
ufefully  employed.  At  the  fame  time,  from  this  con- 
lideration  that  mild  oily  matters  thrown  into  the  in- 
teftines  into  confiderable  quantity  always  prove  laxa- 
tive, I  am  of  opinion  that  the  oleaginous  demulcents 
are  the  mod  uieful*. 

MLXXXVIIL 

*  Some  forms  of  thcfc  demulcents  are  given  in  the  Pharmacopoeia* 
The  following  may  be  added  for  the  fake  of  variety,  as  the  patient 
frequently  loaths  Linclufes. 
%,.  Mann,  opt. 

Ol.  Amygdal.  recent,  a  a  |i. 
Syr.  e  Cort.  aur'ant.  %&• 
M. 

&.  Syr.  althaese. 
Ol.  Amygdal. 
Elect,  lenitiv.  a  a  ?i. 
M. 

^.  Confcrv.  cynolbat.  gi. 
Syr.  rofar. 

Ol.  Amygdal  a  a  §ii. 
M. 

Two  tea-fpoonfuls  of  any  of  the  above  tinctures  may  be  gi?cri 
every  hour,  or  every  other  hour,  drinking,  at  the  fame  time,  bar* 
ley-water  with  bruvfed  prunes  boiled  in  it. 

The  cure  of  a  dyientery  is  briefly  comprehended  in  keeping  the 
belly  open,  and  ufmg  mucilaginous  diluents  and  lubricants. 


O  F    P  H  Y  S  I  C.  65 

ML  XXX  VIII. 

As  this  difeafe  is  fo  often  of  an  Inflammatory  or  of 
a  putrid  nature,  it  is  evident  that  the  diet  employed  in 
it  fhculd  be  vegetable  and  acefcent.  Milk  in  its  en- 
tire Hate  is  of  doubtful  quality  ia  many  cafes;  but 
ibrne  portion  of  the  cream  is  often  allowable,  and 
whey  is.  always  proper. 

In  the  firil  flages  of  the  difeafe,  the  f  \veet  and  fuba- 
cid  fi'uits  are  allowable,  and  even  proper.  It  is  in 
the  more  advanced  flages  only  that  any  morbid  acidi- 
ty feems  to  prevail  in  the  fcomach,  and  to.  require. 
fome  referve  in  the  ufe  of  accfcents.  At  the  beniii- 

O 

ning  of  the  difeafe,  ahfor  bents  feem  to  be  fuperfluous  ; 
•and  by  their  aftringent  and  feptic  powers  they  may  be 
hurtful. 

MLXXXIX. 

When  this  difeafe  is  complicated  with  an  intermit- 
tent fever,  and  is  protracted  from  that  circumuance 
chiefly,  it  is  to  be  treated  as  an  intermittent,  by  ad- 
miniilering  the  Peruvian  bark,  which,  however,  in 
the  earlier  periods  of  the  difeafe,  is  hardly  to  be  ad- 
mitted. 


i 


PART        II. 

O    F 

N.E  u  R  o  s  E  s, 

O   R 

NERVOUS     DISEASES. 

MXC. 

N  a  certain  view,  almofl  the  \vljole  of  the  difeafes 

of  the  human  body  might  be  called   NERVOUS  : 

VOL.  II.  I  but 


uo 


PRACTICE 


but  there  would  be  no  ufe  for  fuch  a  general  appelk- 
tion  ;  and,  on  the  other  hand,  it  feems  improper  to 
limit  the  term,  in  the  loofe  inaccurate  manner  in 
which  it  has  been  hitherto  applied,  to  hyfteric  or  hy- 
pochondiical  diforders,  which  are  themieives  hardly 
to  be  defined  with  fuiiicient  precifion. 

MXCI. 

In  this  place  I'  propofe  to  comprehend,  under  the 
title  of  NEUROSES,  nllthofe  preternatural  afL6tions  of 
fenfe  or  motion  which  are  without  pyrexia,  as  a  part 
of  the  primary  dife;fe;  and  all  thole  which  do  not 
depend  upon  a  topical  affection  of  the  organs,  but  up- 
on a  more  general  affection  of  the  nervous  fyftern, 
and  of  thole  powers  of  the  iyftem  upon  which  fenfe 
and  motion  more  efpecially  depend. 

ivixcu. 

Of  fuch  difeafes  I  have  eftablifhed  a  clafs,  under  the 
title  of  NEUROSES  or  NERVOUS  DISEASES.  Thefe  I 
again  diilinguifh,  as  they  coniiit,  either  in  the  inter- 
ruption and  debility  of  the  powers  of  fenfe  and  moti- 
on, or  in  the  irregularity  with  which  thefe  powers  are 
exercifed  ;  and  have  accordingly  arranged-them  under 
the  four  orders  of  Gomata,  Adynamias^  Spafmi,  and  Ve- 
j'anicz,  to  be  defined  as  we  proceed  to  treat  of  them 
more  particularly. 


B  O  O  K 


O  F    P  H  Y  S  I  C.  67 

BOOK         I. 
OF       C  O  M  A  T  A  ; 

OR,    OF    THE 

LOSS    OF    VOLUNTARY    MOTION. 

MXCIII. 

UNDER  this  title  are  comprehended  thofe  affec- 
tions which  have  been  commonly  called  the 
Soporofe  difeafes  ;'but  they  are  moil  properly  cliftin- 
guiflied  by  their  confiding  in  fome  interruption  or  fup- 
preffion  of  the  powers  of  fenfe  and  voluntary  motion, 
or  of  what  are  called  the  animal  functions.  Thefe 
are  indeed  ufually  fufpended  in  the  time  of  natural 
fleep  :  but  of  ail  the  difeafes  to  be  comprehended  un- 
der our  title,  fleep,  or  even  the  appearance  of  it,  is 
not  conftantly  a  fymptom.  Of  iuch  difeafes  I  can 
mark  and  properly  explain  two  genera  only,  which 
co'me  under  the  titles  of  Apoplexy  and  Palfy. 

„«...<..<  .<.<••<•<••<••<-<••<••<*£>••>••>••  >••>••>••>••>••>  >•>••>•• 
C     I!    A     P.         I. 

OF      APOPLEXY. 

MXCIV. 

A  POPLEXY  is  that  difeafe  in  which  the  whole  of 
JL\.  the  external  and  interaalfenfes,  and  the  whole 
of  the  voluntary  motions,  are  in  fome  degree  abolifh- 
cd  ;  while  refpiration  and  the  action  of  the  heart  con- 

I  2  tinue 


68  PRACTICE 

tlnue  to  b£  performed*.     By  its  being  an  affeftion  of 
the  "jsloole  of  the  powers  of  fenfe  and  of  voluntary 
motion^  we  diftinguifli  it  from  Palfy  ;  and  by  its  be- 
ing with  the  continuance  of  refpi ration  ajid  the  ac- 
tion of  the  heart,  it  is  diftinguiQied  from  Syncips.     I 
have  further  added  to  the  ordinary  definition  of  apo- 
plexy, that  the  abolition  of  the  powers  of  fenfe  and 
motion  is'ui  fome  degree  only  ;  meaning  by  this  to  im- 
ply, that,  under  the  title  of  Apoplexy,  are  here  com- 
prehended thofe  difeafes  which,  as  differing  from  it  in 
degree  only,  cannot,  with  a  view  either  to  pathology 
or  practice,  be  properly  diftinguimed  from  it  :  Such 
are  the  difeafes  fometimes  treated  of  under  the  names 
cf  Car us 9  Catapbaray  Ccmt,  and  Lethargus. 

MXCV. 

Apoplexy,  in  all  its  different  degrees,  mod  common- 
ly atfecls  perfons  advanced  in  life,  and  efpecially  thofe 
above  fix'.y  years  of  age.  It  mod  ufually  affects  perfons 
of  large  heads  and  fliort  necksf ,  perfons  of  a  corpulent 
habir,  perfons  who  hive  palled  an  indolent  life  and  ufed 
a  full  diet,  and  efpecially  thofe  who  have  indulged  in 
frequent  intoxication.  Men  who  have  long  laboured 
und-^r  a  frequent  and  copious  difcharge  of  blood  from 

the 

*  "  The  appearance  of  a  profound  and  continual  fleep,"  is  by 
Boerhaave  judicioufly  added  to  the  definition  of  Apoplexy. 

To  diflinguifh  between  a  profound  deep  and  apoplexy,  which  very 
much  referable  each  other,  is,  however,  extremely  eafy.  A  man  in 
a  profound  deep  may  in  general  be  roufed  by  the  application  of  ftrong 
flimulants  to  the  organ  which  produce  no  effcft  on  an  apo- 

plectic patient, 

T  )  diflitiguifii  between  apoplexy  and  a  fit  of  drnnkenntfs  is  not  fo 
eafy  ;  for  drunken  people  are  fornetimes  incapable  of  being  roufed 
by  any  IHmu'ants,  remaining  totally  infenfiblc  and  motionkfs.  The 
fur.i.-is  of  the  liquor  with  which  they  have  been  intoxicated  may  fome- 
times be  difcovered  by  fmelling  :  a  drunken  lit  may  alfo  be  known  by 
tlie  palenefsof  the  drunken  man's  face,  and  by  his  manner  of  living. 

f  Different  authors,   one  cf  whom  is  Boerhaave,  have  fppofed 
that  a  vertebra  is  wanting/the  neck  confiiling  only  of  fix  iuitcad  of 
ieven  vertebrae. 


OF    PHYSIC.  69 

the  hemorrhoidal  vefTels,   upon  either  the  fuppreffion 
or  fpontaneous  ceafing  of  that  difcharge,  are  particu- 
larly liable  to  be  affected  with  apoplexy. 
MXCVI. 

This  difeafe  frequently  comes  on  very  fuddenly : 
but  in  many  cafes  it  is  preceded  by  various  fymptoms, 
fuch  as  frequent  fits  of  giddinefs,  frequent  headachs,  a 
hemorrhagy  from  the  nofe,  fome  tranfitory  interrup- 
tions of  feeing  and  headng,  fome  falfe  vifion  and  hear- 
ing, fome  tranfitory  degree  of  nurnbnefs  or  lofs  of 
motion  in  the  extremities,  fome  faltering  of  the 
tongue  in  fpeaking,  a  lofs  of  memory,  a  frequent  drow- 
fmefs,  and  frequent  fits  of  incubus* 
MXCVIL 

An  attention  to  thefe  fymptoms,  and  to  the  predif- 
ponent  circumftances,  (MXCV.)  will  often  enable  us  to 
forefee  the  more  violent  attacks  of  this  difeafe. 
MXCVIII. 

When  the  difeafe  comeson  fuddenly. to  aconfiderable 
degree,  it  has  been  frequently  obfervecl  to  have  been 
immediately  induced  by  violent  exercife ;  by  a  full 
and  long  continued  infpiration  ;  by  a  fie  of  anger ;  by 
much  external  heat,  efpecially  that-  arifing  from  a 
crowded  aflembly  of  people ;  by  warm  bathing  ;  by 
intoxication  ;  by  long  (looping  with  the  head  down  ; 
and  a  tight  ligature  about  the  neck.  The  difeafe  has 
been  remarked  to  make  its  attacks  mofl  frequently  in 
the  fpring  feafon,  and  efpecially  when  the  vernal  heat 
fuddenly  iucceeds  to  the  winter  cold. 

MXCIX. 

The  fymptoms  denoting  the  prefence  of  this  dif-' 
cafe  will  be  fufficiently  known  from  the  definition  giv- 
en, MXCIV.  Although  the  whole  of  the  body  is  af- 
fected with  the  lofs  of  fenfe  and  motion,  it  fometimes 
takes  place  more  upon  one  fide  of  the  body  than  the 
other;  and,  in  that  cafe,  the  fide  lead  affected  with 
palfy  is  fcmetimcs  affected  with  convullions.  In  this 

dif* 


7o  PRACTICE 

difeafe  there  is  often  a  ftertorous  breathing;  and  this 
has  been  faid  to  be  a  mark  of  the  moil  violent  fiate  of 
the  difeafe  ;  but  it  is  not  always  prefent  even  in  the 
moil  complete  form  or  mod  violent  degree  of  the  dif- 
eafe, 

MC. 

The  proximate  caufe  of  this  difeafe  may  be,  in  ge- 
neral, whatever  interrupts  the  motion  of  the  nervous 
power  from  the  brain  of  the  mufcles  from  voluntary 
motion  ;  or,  in  fo  far  as  fenfe  is  affected,  whatever 
interrupts  the  motion  of  the  nervous  power  from  the 
isntient  extremities  of  the  nerves  to  the  brain. 

MCI. 

Such  an  interruption  of  the  motions  cf  the  nervous 
power  may  be  occafioned,  either  by  him  ctmprejfion  of 
the  origin  of  the  nerves,  or  by  fome  thing  dejtroying  the 
mobility  of  the  nervous  power.  Both  thefe  cauies  we 
mufl  treat  of  more  particularly  ;  and,  firft,  of  that  of 
Gornpreliion,  feemingly'the  moft  frequent  occaiion  of 
apoplexy,  and  perhvips  the  oecaiiun  of  ail  thole  apo- 
plexies ariiing  from  internal  caufes. 

MCII. 

The  lofs  of  fenfe  and  motion  in  particular  parts  of 
the  body,  may  be  occafioned  by  a  comprelTi  -.n,  either 
of  the  origin  of  certain  nerves  only,  or  of  the  fame 
nerves  in  fume  part  of  their  courfe  from  the  brain  10 
the  organs  of  ienfa  and  motion.  Such  cafes  of  par- 
tial compreiRon  will  be  more  properly  considered 
hereafter  ;  and  the  affection  I  am  now  to  treat  cf  be- 
ing general,  it  mufl  depend  upon  a  very  general  com- 
preilion  of  fhe  origin  of  the  nerves,  or  medullary  por- 
tion of  the  brain ;  and  therefore,  this  more  general 
compreffion  only  is  to  be  coniidered  here. 

MCI1L 

This  compreffion  cf  the  origin  of  the  nerves  or  me* 
dullary  portion  of  the  brain,  may  be  produced  in  dif- 
ferent ways  5  11  o, 

i.  By 


O  F    P  H  Y  S  I  fi.  71 

1.  By  external  violence  fracturing  and  prefling  in  a 
pan  of  the  cranium. 

2.  By  tumours,  foractimes  fofr,   fometimes  bony, 
formed  in  different  parts  of  the  brain,    or  in  its  mern- 
1  rants,    and  becoming  of  fuch  a  bulk  as  to  comprcfs 
the  medullary  fuhftance  of  the  brain. 

3.  By  the  blood   accumulated  in.  the  bloocl-vefFels 
of  the  Drain,  and  diflending  them  to  fuch  a  degree  as 
to  comprefs  the  medullary  portion  of  the  fame. 

4.  .By  fluids  effufed  in  different  parts  of  the  brain, 
rr  into    lu:  cavity  of  the  cranium,  and  accumulated  in 
Lich  tro  ati:y  as  to  occafion  the  compreiEon  we  treat 
of. 

And,  as  to  this  lad,  it  is  to  be  remaiked  here,  that 
the  fluids  effufed  may  be  of  two  kinds  :  that  is,  they 
may  be  either  a  portion  of  the  coirirncn  mafs  of  blood, 
poured  out  fiom  red  veiTels ;  or  a  portion  of  ferurn 
•  or  colouilcfs  fluid,  poured  out  chiefly  by  the  exha- 
farits; 

MCIV. 

Of  thefe  feveral  caufes  of  compreilion,  the  firlT:  is 
not  ro  be  confidered  here,  becaufe  the  removing  it  does 
not  belong  to  our  province ;  and  the  confideration  oi:' 
the  fecond  may  be  omitted,  as  in  moil  inftances  it  is 
neither  to  be  difcerned  nor  cured  by  any  means  yet 
known.  The  third  and  fourth  caufes  of  compreiTion, 
as  they  are  the  moil  frequent,  and  are  alfo  moil  pro- 
perly the  fubjects  of  our  art,  fo  they  are  thofe  which 
deierve  our  particular  attention ;  and  we  mail  there- 
fore endeavour  to  trace  them  further  back  in  the  fe- 
ries  of  caufes  which  may  produce  them. 

MCV. 

Both  the  flates  of  over-diftention  and  of  efFufion, 
tray  be  produced  by  whatever  increafes  the  afflux  and 
impetus  of  the  blood  in  the  arteries  of  the  head  ;  fuch 
as  violent  exercife,  a  violent  fit  of  anger,  external  heat 

applied. 


ya  PRACTICE 

applied,  or  any  flrong  preiTure  upon  the  defcending 
aorta. 

MCVI. 

But  both  thefe  flates  of  over-cliftention  and  of  efFu-* 
fion,  may  alfo  and  feem  to  be  more  frequently  produc- 
ed by  caufes  that  operate  by  preventing  the  free  return 
of  the  venous  blood  from  the  veiTels  of  the  head  to 
the  right  ventricle  of  the  heart. 

MCVIL 

The  venous  veitels  of  the  brain  are  of  a  conforma- 
tion and  diftributionfo  peculiar,  as  lead  us  to  believe* 
that  Nature  intended  to  retard  the  motion  of  the 
blood,  and  accumulate  it  in  thefe  veffels ;  and  there- 
fore, even  very  final  I  additional  refinances  to  the  mo- 
tion of  the  blood  from  thefe  towards  the  right  ventri- 
cle cf  the  heart,  may  Hill  more  readily  accumulate 
the  blood  in  them.  Such  accumulation  will  moil 
readily  happen  in  advanced  life,  when  the  venous  fyf- 
tem  in  general  is  in  a  plethoric  ftate,  and  when  this 
plethora  takes  place  efpecially  in  the  venous  veffels  of 
the  brain.  It  will,  in  like  manner,  be  moil  apt  to  oc- 
cur in  perfons  whofe  heads  are  large  with  refpect  to 
the  reft  of  the  body;  and  in  perfons  of  a  ihort  neck, 
which  is  unfavourable  to  the  return  of  the  venous 
blood  from  the  head.  The  accumulation  of  blood  in 
the  venous  veffels  of  the  brain,  will  alfo  be  moft  likely 
to  occur  in  perfons  of  a  corpulent  habit,  either  be- 
caufe  thefe  may  be  considered  to  be  in  a  plethoric 
flute,  or  becaufc  obciity,  by  occalioning  a  compreffion 
of  the  blocd-vefTels  in  other  parts  of  the  body,  more 
readily  fills  thofe  of  the  brain,  which  are  entirely  free 
from  any  fuch  coinpreflion. 

MGVIII. 

Thefe  are  the  circumftances  in  the  constitution  of 
the  body,  which,  producing  a  (lower  motion  and  re- 
turn of  the  venous  blood  from  the  vefiels  of  the  head, 
favour  an  accumulation  and  difbntion  in  them  ;  and 

we 


OFPHYSIC.  73 

we  now  proceed  to  mention  the  feveral  occaflona! 
caufes,  which,  in  every  perfon,  may  dire&ly  prevent 
the  free  return  of  the  blood  from  the  vefTels  of  the 
head  towards  the  heart.  Such  are, 

1.  Stooping  down  with  the  head,  or  other  fitua- 
tions  of  the  body  in  which  the  head  is  long  kepi;  in  a 
depending  (late,  and  in  which  the  gravity  of  the  blood 
increafes  the  afflux  of  it  by  the  arteries,  and  oppofes 
the  return  of  it  by  the  veins. 

2.  A  tight  ligature  about  the  neck,  which  compreiT- 
es  the  veins  more  itrongly  than  the  arteries. 

3.  Any  obfittidUon  of  a  coniiderable  number  of  the 
veins  carrying  the  blood  from  the  head,   and  more 
efpecially  any  confiderable  obilruction  of  the  afcend- 
ing  vena  cava. 

4.  Any  confiderable  impediment  of  the  free  paf- 
fage  of  the  blood  from  the  veins  into  the  right  ventri- 
cle of  the  heart ;  and  it  is  commonly  by  this,   and  the 
immediately  preceding  circumftance,   that  polypous 
concretions  in  the  cava,  or  right  ventricle,  are  found 
to  occalion  apoplexy. 

5.  The  return  of  blood  from  the  veins  of  the  head 
towards  the  heart,  is  efpecially  interrupted  by  every 
circumftance  that  produces  a  more  difficult  tranfmif- 
iion  of  the  blood  through  the  veiTels  of  the  lungs.  It 
is  well  known,  that,  at  the  end  of  every  expiration, 
fome  interruption  is  given  to  the  free  tranfmiffion  of 
the  blood  through  the  lungs ;  and  that  this  at  the  fame 
time  gives  an  interruption  to  the  motion  of  the  blood 
from  the  veins  into  the  right  ventricle  of  the  heart. 
This  clearly  appears   from  that  regurgitation  of  the 
blood  in  the  veins,  which  occaiions  the  alternate  heav- 
ing and  fubliding  that  is  perceived  in  the  brain  of  liv- 
ing animals  when  the  cranium  is  removed,  and  which 
is  obferved  to  be  fynchronous  with  the  alternate  mo- 
tions of  refpiration.     From  this  we  readily  perceive, 
that  whatever  occaiions  a  difficulty  in  the  tranfmiffion 

VOL.  II.  K  of 


74  PRACTICE 

of  the  blood  through  the  lungs,  muft  alfo  interrupt 
the  free  return  of  the  venous  blood  from  the  vciTels 
of  the  head  ;  and  muft  therefore  favour,  and  perhaps 
produce,  an  accumulation  of  blood,  and  an  over-dif- 
tention  in  thefe  veflels. 

It  is  further  to  be  obfcrved,  that  as  a  very  full  in- 
fpiration, continued  for  any  length  of  time,  occalions 
fuch  an  interruption  of  the  free  tranfmiffion  of  the 
blood  through  the  lungs,  as  produces  a  fuffufion  of 
face,  and  a  manifeft  turgefcence  of  the  blood- veffcls 
of  the  head  and  neck  ;  fo  every  full,  and  long-conti- 
nued infpiration  may  occafion  an  accumulation  of 
blood  in  the  yelTels  of  the  head,  to  a  very  confidera- 
ble  degree.  Thus,  as  every  ftrong  exertion  of  the 
mufcular  force  of  the  body  requires,  and  is  attended 
with,  a  very  full  and  long-continued  infpiration,  we 
thence  learn  why  the  violent  exertions  of  mufcular 
force  have  been  fo  often  the  immediate  or  exciting 
caufes  of  apoplexy. 

It  may  alfo  be  remarked,  that  corpulency  and  obe- 
fity  operate  very  much,  by  occafioning  a  more  difficult 
tranfmiffion  of  the  blood  through  the  verTels  of  the 
lungs.  It  appears,  that  in  fat  perfons,  from  the  com- 
preilion  of  the  blood-vefTels  in  many  parts  of  the  bo- 
dy, the  velTels  of  the  lungs  are  thereby  kept  very  full ; 
fo  that,  upon  the  leaft  increafe  of  bodily  motion, 
which  fends  the  blood  fader  into  the  lungs,  a  more  fre- 
quent and  laborious  refpiration  becomes  in  fuch  per- 
fons immediately  necefTary.  This  fhows,  that,  in  fuch 
perfons,  the  blood  is  not  freely  tranfmitted  through 
the  lungs ;  a  circumftance  which,  as  in  other  inftances, 
muft  give  a  conftant  refiftance  to  the  return  of  blood 
from  the  veffels  of  the  head,  and  therefore  favour  or 
occafion  an  accumulation  of  blood  in  them. 

Is  the  motion  of  the  blood  in  the  veffels  of  the  head 
rendered  flower  by  ftudy,  care  and  anxiety  ? 

MCIX. 


0  F    P  H  Y  S  I  G.  75 

MCIX. 

It  is  to  be  obferved  further,  that  thefe  feveral  cauf- 
.es  (MCV — MCVIII.)  of  a  preternatural  fuinefs  in  the 
-blood- vefleis  of  the  brain,  may  produce  apoplexy  in 
different  ways,  according  as  the  fuinefs  takes  place  in 
the  arteries  or  in  the  veins. 

MCX. 

Accordingly, firft,  the  increafed  afflux  of  blood  in- 
to the  arteries  of  the  brain,,  and  an  increafed  action  in 
thefe,  may  either  occaiion  a  rupture  of  their  extremi- 
ties, and  thereby  an  effufion  of  red  blood  producing 
compreffion ;  or  the  fame  afflux  and  increafed  action 
may  occafion  an  increafed  exhalation  from  their  ex- 
tremities, of  a  ferous  fluid,  which,  if  not  as  quickly 
re-abforbed,  may  foon  accumulate  in  fuch  quantity  as 
to  produce  compreffion. 

MCXL 

Secondly,  The  phletoric  ft  ate  of  the  venous  veflels 
of  the  brain,  may  operate  in  three  different  ways. 

1.  The  fuinefs  of  the  veins  may  give  fuch  refiftance 
to  the  blood  flowing  into  them  from  the  arteries,  as 
to  determine  the  impetus  of  the  blood  to  b$  f )  much 
greater  upon  the  extremities  of  the  arteries  as  to  occa- 
fion a  rupcure  of  thefe,  and  confequently  an  eiFuiion 
of  red  blood,  or  the  Hcemorrhagia   ctrebri,    which 
HOFFMAN  considers  as  a  frequent  caufe  of  apoplexy, 
and  which  we  have  before  explained  in  DCCLXXIT. 

2.  Whilft  the  fame  refiftance  to  the  blood  flowing 
from  the  arteries  into  the  veins,  increafes  the  impetug 
of  the  blood  in  the  former,  this  may,  without  occafi- 
oning  rupture,  increafe  the  exhalation  from  their  ex- 
halant  extremities,  and  produce  an  efFufion  of  a  ferous 
fluid  ;  in  the  fame  manner  as  fuch   refinance  in  the 
veins  produces  hydropic  effuiions  in  other  parts  of  the 
body. 

3.  If  we  may  fuppofe,  as  no  lymphatics  have  been 
yet  difcpvered  in  the  brain,  that  the  ordinary  abforb- 

K  2  ents 


76  PRACTICE 

ents  are  not  prefent  there,  and  that  the  exhaled  fluids 
are  abforbed  or  taken  up  by  the  extremities  of  the 
veins ;  this  will  {how  ftill  more  clearly  that  a  refift- 
ance  to  the  motion  of  the  blood  in  the  veins  of  the 
brain,  may  readily  produce  an  accumulation  of  ferous 
fluid  in  its  cavities,  and  confequcntly  a  compreffion 
producing  apoplexy. 

MCXIL 

Befides  thefe  caufes  of  apoplexy  from  afflux  in  the 
arteries,  or  refiftance  in  the  veins,  an  effufion  of  ferirm 
may  happen  from  two  other  caufes.  The  one  is  a 
relaxation  of  the  exhalants,  as  in  other  cafes  of  hy- 
dropic diatheiis  prevailing  in  the  body ;  and  it  is  not 
unufual  for  a  general  dropfy  to  end  in  apoplexy.  The 
fecond  is  an  over-proportion  of  watery  parts  in  the 
mafs  of  blood,  which  is  therefore  ready  to  run  off  by 
the  exhalants,  as  in  the  cafe  of  an  ifchuria  renalis ; 
which,  when  it  proves  incurable,  very  commonly  ter- 
minates in  apoplexy. 

MCXIIL 

We  have  now  mentioned  the  feveral  caufes  of  apo- 
plexy depending  upon  compreffion  ;  and  from  the 
whole  it  will  appear,  that  the  moft  frequent  of  all 
thefe  caufes  is  a  plethoric  ftate,  or  an  accumulation 
and  congeftion  of  blood  in  the  venous  veifels  of  the 
head,  operating,  according  to  its  degree,  in  produc- 
ing over-ciiltention  or  effufion.  The  frequent  opera- 
tion of  fuch  acaufe  will  efpecially  appear  from  acon- 
iideration  of  the  predifponent  circumftances  (MXCV.) 
and  from  the  antecedent  fymptoms.  (MXCVI.) 

MCXIV. 

From  the  view  I  have  now  given  of  the  caufes  of 
apoplexy  ariiing  from  compreffion,  it  will  readily  ap- 
pear that  there  is  a  foundation  for  the  common  dif- 
tinclion  of  this  difeafe  into  the  two  kinds  of  Sanguine 
and  Serous.  But  this  diftin&ion  cannot  be  very  ufe- 
fully  applied  in  pra&ice,  as  both  kinds,  may  often  de- 
pend 


OF    PHYSIC.  77 

pend  on  the  fame  caufe,  that  is,  a  venous  plethora,  and 
therefore  requiring  very  nearly  the  fame  method  of 
cure,  The  only  diftinction  that  can  be  properly  made 
of  apoplexies  from  cornpreffion,  is  perhaps  tiie  difc 
tinchon  of  ferous  apoplexy,  into  that  depending  on 
the  plethora  mentioned  MCXIII.  and  that  depending 
upon  hydropic  diathefis,  or  an  over-proportion  of  wa- 
ter in  the  blood  (MCXII.)  the  former  caufes  giving, a 
proper  idiopathic,  the  latter  only  a  fymptomatic,  dik 
•eafe. 

MCXV. 

Befidethe  caufes  now  mentioned,  occaficning  apo- 
plexy by  compreffion,  I  alledge  there  are  other  caufes 
producing  the  fame  difeafe,  by  directly  deftroying  the 
mobility  of  the  nervous  power.  Such  caufes  feem  to 
be  the  mephtic  ariiing  from  fermenting  liquors,  and 
from  many  other  fources ;  the  fumes  ariiing  from 
burning  charcoal,  the  fames  of  mercury,  of  lead*  and 
of  fame  other  metallic  fubftances ;  opium,  alcohol, 
and  many  other  narcotic  poifons  :  To  all  which  I 
would  add  the  power  of  cold,  of  concuffion,  of  electri- 
city, and  of  certain  paflions  of  the  mind. 
MCXVI. 

None  of  thefe  pcifons  or  noxious  powers  feem  to 
kill  by  acting  firfl  upon  the  organs  of  refpiration,  or 
upon  the  fanguiferous  fyftem  ;  and  I  believe  their  im- 
mediate and  direct  action  to  be  upon  the  nervous  pow- 
er, deftroying  its  mobility,  becaufe  the  fame  poifons 
{how  their  power  in  deflroying  the  irritability  of  muf- 
cles  and  of  the  nerves  connected  with  them,  when 
both  thefe  are  entirely  feparated  from  the  reft  of  the 
body. 

MCXVII. 

It  appears  to  me  probable  that  the  apoplectic  flats 
infome  degree  accompanying,  and  al moil  always  fuc- 
ceeding,  an  epileptic  paroxyfrn,  does  not  depend  upon 
compreflion?  but  upon  a  certain  flateof  immobility  of 

the 


3  PRACTICE 


the  nervous  power,  produced  by  certain  circumftan- 
ces  in  the  nervous  fyftem  itfelf,  which  fometimes  fcem 
to  be  communicated  from  one  part  of  the  body  to  ano- 
ther, and  at  length  to  the  brain. 
MCXV1II. 

The  fame  obfervation  may  be  made  with  refped  to 
many  inftances  of  hyfteric  paroxyfm ;  and  the  circum. 
fiances,  both  of  epileptic  and  hyfteric  paroxyfms,  end- 
ing in  coma,  or  a  degree  of  apoplexy,  lead  me  to 
think,  that  alfo  the  apoplexy  proceeding  from  retro- 
cedent  or  atonic  gout  is  of  the  fame  kind,  or  that  it 
depends  upon  an  immobility  of  the  nervous  power, 
rather  than  upon  compreflion. 
MCXIX. 

It  may  indeed  happen,  that  as  the  apoplectic  and 
gouty  pred if pofi dons  do  often  concur  in  the  fame 
perfon  ;  fo  it  may  frequently  happen,  that  the  apo- 
plexy coming  upon  gouty  perfons,  may  fometimes  de- 
pend upon  compreflion  ;  and  diffeftions  may,  accord- 
ingly, difcover  that  the  circumftances  of  fuch  a  caufe 
had  preceded.  But,  in  many  cafes  of  apoplexy  fol- 
lowing a  retrocedent,  or  atonic  gout,  no  fuch  antece- 
dent or  concomitant  circumftances,  as  commonly  oc- 
cur in  cafes  of  compreffion,  do  diftin&ly  or  clearly  ap- 
pear; while  others  prefent  themfelves,  which  point 
out  an  affection  of  the  nervous  power  alone. 

MCXX. 

With  refpect,  however,  to  the  circumftances  which 
may  appear  upon  the  direction  of  perfons  dead  of  a- 
poplexy,  there  may  be  fome  fallacy  in  judging,  from 
thofe  circumftances,  of  the  caufe  of  the  difeafe. 
Whatever  takes  off  or  diminifhes  the  mobility  of  the 
nervous  power,  may  very  much  retard  the  motion  of 
the  blood  in  the  veflels  of  the  brain ;  and  that  perhaps 
to  the  degree  of  increafing  exhalation,  or  even  of  oc- 
caiioning  rupture  and  cffufion  :  fo  that,  in  fuch  cafes, 
the  marks  of  compreflion  may  appear,  upon  difledion, 

though 


O  F    P  H  Y  S  I  C.  79 

though  the  difeafe  had  truly  depended  on  caufes  de- 
ftroying  the  mobility  of  the  nervous  power.  This 
feems  to  be  illuftrated  and  confirmed  from  what  oc- 
curs in  many  cafes  of  epilepfy.  In  fome  of  thefe,  af- 
ter a  repetition  of  fits,  recovered  from  in  the  ufual 
manner,  a  fatuity  is  induced,  which  commonly  de- 
pends upon  a  watery  inundation  of  the  brain  :  And 
in  other  cafes  of  epilepfy,  when  fits  have  been  often 
repeated  without  any  permanent  confequence,  there 
happens  at  length  afatalparoxyfm;  and  upon  diiTcdtion 
it  appears,  that  an  effufion  of  blood  had  happened.  This, 
Ithink,istobeconfideredasacaufeofdeath,  notasacaufe 
of  the  difeafe  :  for  in  fuch  cafes,  I  fuppofe  that  the 
difeafe  had  diminifhed  the  aclion  of  the  velTels  of  the 
brain,  and  thereby  had  given  occafion  to  a  flagnation, 
Which  produced  the  appearances  mentioned.  And  I 
apprehend  the  fame  reasoning  will  apply  to  the  cafes 
of  retrocedent  gout,  which,  by  deflroying  the  energy 
of  the  brain,  may  occafion  fuch  a  ftagnation  as  will 
produce  rupture,  effufion,  and  death ;  and  in  fuch  a 
cafe,  the  appearances  upon  diffe&ion  might  lead  us  to 
think  that  the  apoplexy  had  depended  entirely  upon 
compreflion. 

MCXXI. 

The  feveral  caufes  mentioned  in  MCXV.  are  often 
of  fuch  power  as  to  occafion  immediate  death  ;  and 
therefore  have  not  commonly  been  taken  notice  of  as 
affording  inftances-  of  apoplexy  ;  but,  as  the  operation 
of  the  whole  of  thefe  caufes  is  fimilar  and  analogous, 
and  as  in  moft  inftances  of  the  operation  of  thefe  caufes 
an  apoplectic  ftate  is  manifestly  produced,  there  can 
be  little  doubt  in  confidcring  mod  of  the  inftances  of 
their  effects  as  cafes  of  apoplexy,  and  therefore  fuch 
as  fall  properly  under  our  confideration  here. 
MCXXIl, 

This  difeafe  of  apoplexy  is  fometimes  entirely   re- 
covered from  ;  but  more  frequently  it  ends  in  death, 

or 


So  P  R  A  C  T  ICE 

or  in  a  hemiplegia.  Even  when  an  attack  of  the  dlf- 
eaie  is  recovered  from,  we  generally  find  it  diipofed 
to  return ;  and  the  repeated  attacks  of  it  almoii  al- 
ways, iboner  or  later,  bring  on  the  events  we  have 
mentioned. 

MCXXIII. 

The  feveral  events  of  this  difeafe,  in  health,  death, 
or  another  difeafe,  may  be  expected  and  forefeen  from 
a  confideration  of  the  predilponent  circumftances 
(MXCV,);  of  the  antecedent  fymptoms  (MXCVI.)  ;  of 
the  exciting  caufes  (MXCVIII.);  of  the  violence  and 
degree  of  the  fymptoms  when  the  difeafe  has  corne  on 
(MXCIV.)  ;  of  the  duration  of  the  difeafe  ;  and  of  the 
effects  of  the  remedies  employed. 
MCXXIV. 

From  the  great  danger  attending  this  difeafe  when 
it  has  come  on  (MCXXU.),  it  will  readily  appear  that 
our  care  fhould  be  chiefly  directed  to  the  prevention 
of  it.  This,  I  think,  may  be  often  done  by  avoiding 
the  remote  and  exciting  caufes ;  and  how  this  may  be 
accomplished,  will  be  obvious  from  the  enumeration 
of  thofe  caufes  given  above  (MXCVIII.)  But  it  will  alfo 
appear  from  what  is  faid  above,  that  the  prevention 
of  this  difeafe  will  efpecially  depend  upon  obviating 
the  predilponent  caufe  ;  which,  in  moft  cafes,  feems 
to  be  a  plethoric  (late  of  the  blood- veffels  of  the  brain. 
This,  I  think,  may  be  obviated  by  different  means ; 
and,  in  the  firft  place,  by  a  proper  management  of  ex- 
ercife  and  diet. 

MCXXV. 

The  exercife  ought  to  be  fuch  as  may  fupport  the 
perfpiration,  without  heating  the  body  or  hurrying  ref- 
piration  ;  and,  therefore  commonly  by  fome  mode  of 
geitation.  In  perfons  not  liable  to  frequent  iits  of 
giddinefs,  and  who  are  accuftoirr-  J  to  riding  on  horfe- 
back,  this  exercife  is,  of  all  others,  the  belt.  Walk- 
ing, and  fome  other  modes  of  bodily  exercife,  may  be 

em- 


O  F    P  H  Y  S  I  C.  Si 

employed  with  the  reftriclions  jufl  now  mentioned  ; 
but  in  old  men,  and  in  men  of  corpulent  habits,  bodi- 
ly exercife  ought  always  to  b'e  very  moderate. 
MCXXVL 

In  perfons  who  pretty  early  in  life  (how  the  predif- 
poiition  to  apoplexy,  it  is  probable  that  a  low  diet, 
with  a  good  deal  of  exercife,  might  entirely  prevent 
the  difeafe ;  but,  in  perfons  who  are  advanced  in  life 
before  they  think  of  taking  precautions,  and  are  at  the 
fame  time  of  a  corpulent  habit,  which  generally  iup* 
pofes  their  having  been  accuftomed  to  full  living,  it 
might  not  be  fafe  to  put  them  upon  a  low  diet :  and 
it  may  be  enough  that  their  diet  be  rendered  more 
moderate  than  ufual,  efpecially  with  refpeft  to  animal- 
food  ;  and  that,  at  fupper,  fuch  food  ihould  be  ab- 
ftained  from  altogether. 

In  drinking,  all  heating  liquors  are  to  be  abftained 
from,  as  much  as  former  habits  will  allow  ;  arid  the 
fmalielfc  approach  to  intoxication  is  to  be  carefully 
ihunned.  For  ordinary  draught,  fmall  beer  is  to  be 
preferred  to  plain  water,  as  the  latter  is  more  ready  to 
occaiion  coflivenefs,  which  in  apoplectic  habits  is  to  be 
carefully  avoided.  The  large  ufe  of  tobacco  in  any 
fliape  may  be  hurtful ;  and  except  in  cafes  where  it 
has  been  accuftomed  to  occaiion  a  copious  excretion 
from  the  head,  the  interruption  of  which  might  not 
be  fafej  the  ufe  of  tobacco  ihould  be  avoided ;  and 
even  in  thecircumftance  mentioned,  where  it  may  be 
in  fome  meaning  neceflary,  the  ufe  of  it  fhould  at  lead; 
be  rendered  as  moderate  as  poflible. 
MCXXV1I. 

Evacuations  by  flool  may  certainly  contribute  to 
relieve  the  plethoric  fcateof  the  veifels  of  the  head  ; 
and,  upon  appearance  of  any  unufual  turgefcence  in 
thefe,  purging  will  be  very  properly  employed  :  but, 
when  no  fuch  turgefcence  appears,  the  frequent  repe- 
tition of  large  purging  might  weaken  the  body  too 

VOL.  II.  L  much; 


82  PRACTICE 

much  ;  and,  for  preventing  apoplexy,  it  may  for  the 
mod  part  be  enough  to  keep  the  belly  regular,  and 
rather  open,  by  gentle  laxatives*.  In  the  fummer 
fealon,  it  may  be  ufeful  to  drink,  every  morning,  of 
a  gentle  laxative  mineral  'water,  but  never  in  large 
quantity. 

MCXXVJII. 

In  the  cafe  of  a  plethoric  ft  ate  of  the  fyflem,  it 
might  be  fuppofed  that  blood-letting  would  be  the 
moil  effectual  means  of  diminifhing  the  plethora,  and 
of  preventing  its  confequcnces ;  and,  when  an  attack 
of  apoplexy  is  immediately  threatened,  blood-letting 
is  certainly  the  remedy  to  be  depended  upon  ;  and 
blood  mould  be  taken  largely,  if  it  can  be  done,  from 
the  jugular  vein,  or  temporal  artery.  But,  when 
no  threatening  turgefcence  appears,  the  obviating 
plethora  is  not  judicioufly  attempted  by  blood-let- 
ting, as  we  have  endeavoured  to  demonftrate  above, 
DCCLXXXVU.  In  doubtful  circumftances,  leeches  ap- 
plied to  the  temples  or  icarifications  of  the  hind-head, 
may  be  more  fafe  than  general  bleedings. 

MCXXIX. 

When  there  are  manifeft  fymptoms  of  a  plethoric 
Hate  in  the  veifels  of  the  head>  a  feton,  or  pea-ifliie, 
near  the  head,  may  be  very  ufeful  in  obviating  any 
turgefcence  of  the  blood. 

MCXXX. 

Thcfe  are  the  means  to  be  employed  for  preventing 

the 

*  Gentle  laxatives  have  been  often  enumerated  in  the  preceding 
notes.  In.  thefe  cafes,  however,  there  is  no  danger  to  be  apprehend- 
ed from  the  ufe  of  the  refmous  draftics,  provided  that  they  are  not 
given  in  fuch  dofes  as  may  weaken  the  patient  too  much.  They 
ought  to  be  ufed  for  the  purpofe  of  purging,  but  only  for  keeping 
the  body  moderately  open  ;  and  this  eftc6t  may  be  fafely  produced 
by  five  or  eight  grains  of  Rufus's  pills  taken  occafionally  at  bed-time, 
or  by  a  tea-fpoonful  or  two  of  the  Tinct.  jalap,  or  a  table -fpoonful 
of  the  elixir  fennae  in  the  morning.  The  fame  end  may,  in  many 
f  afes,  be  anfwered  by  a  due  attention  to  diet. 


O  F    P  H  Y  S  I  C.  83 

the  apoplexy  which  might  arife  from  a  plethoric  ftate 
of  the  veflels  of  the  brain;  and  if,  at  the  fame  time, 
great  care  is  taken  to  avoid  the  exciting  caufes  (MXC- 
vm.),  thefe  means  will  be  generally  fuccefsful. 

In  the  cafes  proceeding  from  other  caufes  (MCXV.), 
as  their  application  is  fo  immediately  fuccceded  by 
the  difaafe,  they  hardly  allow  any  opportunity  for  pre- 
vention. 

MCXXXI. 

For  the  CURE  of  apoplexies  from  internal  caufes, 
and  which  I  fuppofe  to  be  chiefly  thofe  from  comprefr 
fion,  the  ufual  violence  and  fatality  of  it  require  that 
the  proper  remedies  be  immediately  and  largely  em- 
ployed. 

The  patient  is  to  be  kept  as  much  as  poffible  in 
fomewhat  of  an  erect  poflure,  and  in  cool  air,  and 
therefore  neither  in  a  warm  chamber,  nor  covered 
with  bed-clothes,  nor  furrounded  with  a  crowd  of 
people. 

MCXXXII. 

In  all  cafes  of  a  full  habit,  and  where  the  difeafe 
has  been  preceded  by  marks  of  a  plethoric  ftate,  blood- 
letting is  to  be  immediately  employed,  and  very  large- 
ly. In  my  opinion,  it  will  be  moil  effectual  when  the 
blood  is  taken  from  the  jugular  vein  ;  but  if  that  can- 
not be  properly  done,  it  may  be  taken  from  the  arm. 
The  opening  of  the  temporal  artery,  when  a  large 
branch  can  be  opened,  fo  as  fuddeniy  to  pour  out  a 
confiderable  quantity  of  blood,  may  alfo  be  an  effectu- 
al remedy ;  but,  in  execution,  it  is  more  uncertain, 
and  may  be  inconvenient.  It  may  be,  in  fome  mea- 
fure  fupplied,  by  cupping  and  fcanfyingon  the  tem- 
ples or  hind-head.  This,  indeed,  fhould  feldom  be 
omitted  :  and  thefe  fcarifications  are  always  prererable 
to  che  application  of  leeches. 

With  refpect  to  every  mode  of  blood-letting,   this 
is  to  be  obferved,  that  when  in  any  cafe  of  apoplexy, 

L  2  '  it 


S4  PRACTICE 

it  can  be  perceived  that  one  lide  of  the  body  is  more 
affefted  with  the  iofs  of  motion  than  the  other,  the 
blood-letting,  if  poffible,  fhould  be  made  on  the  fide 
oppoiite  to  that  moil  affected*. 

MCXXXIII. 

Another  remedy  to  be  employed  is  purging,  to  be 
immediately  attempted  by  acrid  glyfters§  ;  and  at 
the  fame  time,  if  any  power  of  fwallowing  remain, 
by  draftic  purgatives  given  by  the  mouth.  Thefe, 
however,  left  they  may  excite  vomiting,  fhouldbe 
given  in  divided  portions  at  proper  intervals-}*. 
MGXXX1V.  . 

Vomiting  has  been   commended   by  forne  pracli- 
tioners  and  writers:  but,  apprehending  that  this  might 

impel 

*  DifTe&ions  (hew  that  the  congestions  producing  apoplexy  are  al- 
ways on  the  fide  not  affected;  and  hence  the  propriety  of  the  direction, 
§   Acrid  clyfters  are, 

&.  EleA.  lenitiv.  Ji.* 

Sal,  cathartic,  amar.  Jiifs. 
Aq.  tepid.  §xi. 
M.  f.  Enema. 
R.  Sapcm.  alb.  ^ifs. 

Solve  in  aq.  tepid,  jx.  cui  addc 
Syr.  e  ipina  cerv.  ^ii. 
M.  f.  Enema. 
R.  Pulp,  colocynth.    §iii. 

Coque  per   horse  quadrantem  in  nq.  font. 

q.  f-  ad  colutarse  ^xii.  cui  adde 
Oi.  Olivar.  51. 
M.  f.  Enema, 

•f-  The  draftic  purges  are,  in  thefe  cafes,  to  be  given  in  draughts, 
rather  than  in  pilis  or  bohifes  ;  the  following  form  may  be  uicd  ; 
$.  Pulv.  jalap.  5i. 
Rad,  zinzib.  3i- 
Infuf,  ftrn.  liui  tiii.' 
M. 

The  dofe  of  this  mixture  is  two  fpoonfiu'j  every  two  hours  li«l  it  o- 
peratc  :  or  we  may  ufe  one  of  the  formulae  mentioned  in  the  note 
on  article  1080,  especially  the  laii,  repeating  it  every  two  hours  till 
it  produces  an  effect. 


O  F    P  H  Y  S  I  G.  85 

impel  the  blood  with  too  much  violence  into  the  vef- 
fels  of  the  head,  I  have  never  employed  it. 

MCXXXV. 

Another  remedy  to  be  immediately  employed  is 
"bliftering ;  arcl  1  judge  that  this  is  more  effectual  when 
applied  to  the  head,  or  near  to  it,  than  when  it  is  ap- 
plied to  the  lower  extremities.  This  remedy  I  do 
not  corifider  as  a  ftimulant,  or  capable  of  making  any 
confide;  able  revulfion ;  but,  applied  to  the  head,  I 
fuppofe  it  ufeful  in  taking  off  the  hemorrhagic  difpo- 
litionfo  often  prevailing  there. 

MCXXXVI. 

It  has  been  ufual  with  practitioners,  together  with 
the  remedies  already  mentioned,  to  employ  ftimulants 
of  various  kinds  ;  but  I  am  difpofed  to  think  them 
generally  hurtful;  and  they  mult  be  fo,  wherever  the 
fulnefs  of  the  vefieh,  and  the  impetus  of  the  blood  in 
thefe,  is  to  be  diminiihed.  Upon  this  principle  it  is 
therefore  agreed,  that  itimulants  are  abfolutely  impro- 
per in  what  is  fuppofed  to  be  a  fanguine  apoplexy  ; 
but  they  are  commonly  fuppofed  to  be  proper  in  the 
ferous.  If,  however,  we  be  right  in  alledging  that 
this  alfo  commonly  depends  upon  a  plethoric  flate  of 
the  blood-velfels  of  the  brain,  ftimulants  mufl  be 
equally  improper  in  the  one  cafe  as  in  the  other. 
MCXXXVII. 

It  may  be  argued  from  the  almofl  univerfal  employ- 
ment of  ftimulants,  and  fometimes  with  feeming  ad- 
vantage, that  they  may  not  be  fo  hurtful  as  my  no- 
tions of  the  caufes  of  apoplexy  lead  me  to  fuppofe. 
But  this  argument  is,  in  feveral  refpeds,  fallacious  ; 
arid  particularly  in  this,  that  in  a  difeafe  which,  un- 
der every  management,  often  proceeds  fo  quickly  to, 
a  fatal  termination,  the  effects  of  remedies  are  not  to  be 
eafily  afcertained. 

MCXXXVIII. 

I  have  now  mentioned  the  feverai  remedies  which 

I  think 


86  PRACTICE 

I  chink  adapted  to  the  cure  of  apoplexy  arifmg 
from  compreffion,  and  fhould  next  proceed  to 
treat:  of  the  cure  of  apoplexy  ariiing  from  thofe 
caufes  that  directly  deftroy  the  mobility  of  the 
nervous  power.  But  many  of  thofe  caufes  are  often 
fo  powerful,  and  thereby  fo  fuddenly  fatal  in  their  ef- 
fe6ts,  as  hardly  to  allow  of  time  for  the  ufe  of  reme- 
dies ;  and  fuch  caH  s,  therefore,  have  been  fo  feldom 
the  fubjc&s  of  prn&ice,  that  the  proper  remedies  are 
not  fo  well  afceriained  as  to  enable  me  to  fay  much  of 
them  here. 

MGXXXIX. 

When,  however,  the  application  of  the  caufes, 
(MCXV.)  is  not  fo  powerful  as  immediately  to  kill,  and 
induces  only  an  apoplectic  ftate,  fome  efforts  are  to  be 
made  to  obviate  the  confequences,  and  to  recover  the 
patient ;  and  even  in  foaie  cafes  where  the  caufes  re- 
ferred to,  from  thecealing  of  the  pulfe  and  of  refpira- 
tion,  and  from  a  coldnefs  coming  upon  the  body,  have 
induced  an  appearance  of  death  ;  yet,  if  thefe  appear- 
ances have  not  continued  long,  there  may  be  means  of 
recovering  the  perfons  to  life  and  health.  I  cannot, 
indeed,  treat  this  fubject  completely  j  but  for  the  cure 
of  apoplexy  from  feveral  of  the  caufes  mentioned 
MCXV,  fnall  offer  the  following  general  directions. 

1.  When  a  poiibn  capable  of  producing  apoplexy 
has  been  recently  taken  into  the  ftomach,  if  a  vomit- 
ing fpontaneouily  arifes,  it  is  to  be  encouraged  ;  or,  if 
it  does  not  fpontaneoufly  come  on,  a  vomiting  is  to  be 
immediately  excited   by  art,  in  order  that  the  poifon 
may  be  thrown  out  as  quickly  as  poflible.     If,  howe- 
ver, the  poifon  has  been  taken  into  the.ilomach  long 
before  its  effects  have  appeared,  we  judge  that,  upon 
their  appearance,    the  exciting  of  vomiting  will   bs 
ufelefs,  and  may  perhaps  be  hurtful. 

2.  When  the  poifon   taken  into  the  ftomach,  or 
otherwife  applied  to  the  body,    has  already  induced  a,n 

apo- 


O  F    P  H  Y  S  I  C:  87 

apoplectic  ftate,  as  thofe  caufes  do  commonly  at  the 
fame  time  occafion  a  ftagnatron  or  flower  motion  of 
the  blood  in  the  vtflels  of  the  brain  and  of  the  lungs, 
fo  it  will  generally  be  proper  to  relieve  this  congdtion 
by  taking  fome  blood  from  the  jugular  vein,  or  from 
the  veins  of  the  arm. 

3.  Upon  the  fame  fuppolition  of  a  congeftion  in  the 
brain  or  lungs,  it  will  generally  be  proper  to  relieve  it 
by  means  of  acrid  glyfters  producing  fome  evacuation 
from  the  inteftines. 

4.  When   thefe  evacuations  by  blood-letting   and 
purging  have  been  made,  the  various  ftimulants  which 
have  been  commonly  propofed  in  other  cafes  of  apo 
plexy,  may  be  employed  here  with  more  probability 
and  fafety*.     One  of  the  mofl  effectual  means  of  rouf- 
ing  apoplectics  of  this  kind  feerns  to  be  throwing  cold 
water  on  feveral  parts  of  the  body,  or  warning  the  bo- 
dy all  over  with  it. 

5.  Although  the   poifon  producing  apoplexy  hap- 
pens to  be  fo  powerful  as  very  foon  to  occafion  the  ap- 
pearances of  death  above-mentioned  ;  yet  if  this  ftate 
has  not  continued  long,  the  patient  may  ofcen  be  re- 
coverable ;  and  the  recovery  is  to  be  attempted  by  the 
fame    means  that  are  directed  to  be  employed  for  the 
recovery   of  drowned  perfons,  and  which  are   now 
commonly  known. 

CHAP. 

k  The  ftimulants  arc  various  according  to  the  various  parts  of  the 
body  to  which  they  are  generally  applied,  as  volatile  and  vinous  fpi- 
rits,  or  vinegar,  to  the  nofe  an.i  temples  ;  acrid  cfiVntial  oils,  mixed 
with  thrice  their  weight  in  hog's  lard,  to  ih •;  buatl  and  back  ;  bli- 
i:ters?  hot  finapifms,  and  warm  fomentations,  wkri  t'orfe-radifh,  to  the 
extremities  ;  frictions  with  warm  brushes  ;  the  aihial  cautery  to  the 
foles  of  the  fee:,  and  palms  of  the  hands;  with  frveral  others,  which 
are  more  particularly  defcribed  in  the  notes  on  article  1161,  et  feq. 


PRACTICE 

CHAP.        II. 
O  $    PALSY. 

MCXL. 

ALSY  js  a  difeafe  confiftkigin  a  lofs  of  the  pow- 
er of  Voluntary  motion,  but  affecting  certain 
parts  of  the  body  only,  and  by  this  it  is  diftinguifhed 
from  apoplexy.  (MXCIV.)  One  of  the  moil  frequent 
forms  of  palfy  is  when  it  affecls  the  whole  of  the  muf- 
cles  on  one  fide  of  the  body  ;  and  then  the  difeaic  is 
named  a  Hewpkgia. 

MCXLI. 

The  lofs  of  the  power  of  voluntary  motion  inr.y 
be  owing  either  to  a  morbid  affection  of  the  mufcles  or 
organs  of  motion,  by  which  they  are  rendered  unfit 
for  motion  ;  or  to  an  interruption  of  the  influx  of  the 
nervous  power  into  them,  which  is  always  necefikry 
to  the  motions  of  thoie  that  are  under  the  power  of 
the  will.  The  difeafe,  from  the  fir  it  of  theie  caufes, 
as  confifting  in  an  organic  and  local  affect ion,  we  refer 
entirely  to  the  clafs  of  local  difeafes.  I  am  here  to 
confider  that  difeafe  only  which  depends  upon  the  in- 
terrupted influx  of  the  nervous  power  ;  and  it  is  to 
this  difeafe  alone  I  would  give  the  appellation  of 
Palfy.  A  difeafe  depending  on  an  interrupted  influx 
of  the  nervous  power,  may  indeed  ofcen  appear  as 
merely  a  local  affection  ;  but  as  it  depends  upon  an 
affection  of  the  mod  general  powers  of  the  fyftem,  it 
cannot  be  properly  ieparatcd  from  the  fyfteinatic  af- 
fections. 

MCXL1L 

In  palfy,  the  lofs  of  motion  is  often  accompanied 
with  the  lofs  of  fenfe  ;  but  as  this  is  not  constantly  the 
cafe,  and  as  therefore  the  lofs  of  fenfe  is  not  an  effen- 

tial 


OF    PHYSIC.  89 

tial  fymptom  of  palfy,  I  have  not  taken  it  into  my  defi- 
nition (MCXL.);  and  I  fhall  not  think  it  neceffary  to 
take  any  further  notice  of  it  in  this  treatife  ;  becaufe, 
in  fo  far  as  it  is  in  any  cafe  a  part  of  the  paralytic  af- 
feclion,  it  mud  depend  upon  the  fame  caufes,  and 
will  be  cured  alfo  by  the  very  fame  remedies,  as  the 
lofs  of  motion. 

MCXLIIL 

The  palfy  then,  or  lofs  of  motion,  which  is  to  be 
treated  of  here,  may  be  diftinguifhed  as  of  two  kinds ; 
one  of  them  depending  upon  an  affe&ion  of  the  origin 
of  the  nerves  in-  the  brain,  and  the  other  depending 
upon  an  affe&ion  of  the  nerves  in  fome  part  of  their 
courfc  between  the  brain  and  the  organs  of  motion. 
Of  the  latter,  as  appearing  in  a  very  partial  affection, 
I  am  not  to  fpeak  particularly  here  ;  I  ihall  only 
treat  of  the  more  general  paralytic  affections,  and  ef- 
pecially  of  the  hemiplegia  (MCXL.)  At  the  fame  time 
I  expect,  that  what  I  Ihall  fay  upon  this  fubject  will 
readily  apply  to  both  the  pathology  and  practice  in 
the  cafes  of  affections  more  limited. 

MCXLIV. 

The  hemiplegia  (MCXL.)  ufually  begins  with,  or 
follows,  a  paroxyfm  of  apoplexy  ;  and  when  the  he- 
miplegia, $fter  fubfifting  for  fome  time,  becomes  fatal, 
it  is  commonly  by  pafling  again  into  the  (late  of  apo- 
plexy. The  relation  therefore  or  affinity  between  the 
two  difeafes,  is  iufficiently  evident ;  and  it  is  further 
ftrongiy  confirmed  by  this,  that  the  hemiplegia  comes 
upon  perfons  of  the  feme  conftitution  (MXCV.),  and  is 
preceded  by  the  fame  fymptoms  (MXCVIII.),  that  have 
been  taken  notice  of  with  refpect  to  apoplexy. 

MCXLV. 

When  a  fit  of  apoplexy  has  gone  off,  and  there  re- 
mains a  (late  of  palfy  appearing  as  a  partial  aff.c^ion 
only,    it   might   perhaps  be   fuppofed  that  the  origin 
of  the  nerves  i>  in  a  grtai  meafuie  relieved;  but  in  fo 
VOL.  II.  M  far 


9C5 


PRACTICE 


far  as  commonly  there  flill  remain  the  fymptoms  of 
the  lofs  of  memory,  and  of  fome  degree  of  fituity, 
thefc,  I  think,  (how,  that  the  organ  of  intellect,  or 
the  common  origin  of  the  nerves,  is  flill  coniiderably 
affeded. 

MCXLVI. 

Thus,  the  hemiplegia,  from  its  evident  conne&icn 
with,  and  near  relation  to,  apoplexy,  may  he  properly 
conlidered  as  depending  upon  like  cauies  ;  and  con- 
fequently,  either  upon  a  compreffion  preventing  the 
flow  of  the  nervous  power  from  the  brain  into  the  or- 
gans of  motion,  or  upon  the  application  of  narcotic  or 
other  powers  (MCXV.)  rendering  the  nervous  power 
unfit  to  How  in  the  uftial  and  proper  manner. 
MCXLVIl. 

We  begin  with  confidering  the  cafes  depending  upon 
comprefiion. 

The  comprefiion  occafioning  hemiplegia  may  be  of 
the  fame  kind,  and  of  all  the  different  kinds  that  pro- 
duce apoplexy  ;  and  therefore  either  from  tumour,, 
over-diftenfion,  or  effufion.  The  exigence  of  tumour 
giving  compreffion,  may  often  be  better  difcerned  in 
the  cafe  of  palfy  than  in  that  of  apoplexy,  as  its  effects 
often  appear  atfirfl  in  a  very  partial  affection* 
MCXLVIIL 

The  other  modes  of  compreffion,  that  is,  of  over- 
diftenfion  and  effufion,  may,  and  commonly  do,  take 
place,  in  hemiplegia  :  and  when  they  do,  their  opera- 
tion here  differs  from  that  producing  apoplexy,  by  its 
effecls  being  partial,  and  on  one  fide  of  the  body  only. 

It  nay  fe^m  difficult  to  conceive  that  an  over-dif- 
tcnficn  can  take  place  in  ^he  veflHs  on  one  fide  of  the 
brain  only  ;  but  it  may  be  underflood  :  and  in  the  cafe 
oi  a  paiiy  which  is  both  partial  and  tranlitory,  it  is  per- 
haps the  only  condition  of  the  vefTels  of  the  brain  th-.it 
can  be  fuppofed,  In  a  hemiplegia,  indeed,  which  fub- 
fiftsfor  any  length  of  time,  there  is  probably  always 

an 


O  F     P  H  Y  S  I  C.  91 

an  effufion,  either  fanguine  or  ferous :   but.  it  is  likely 
that  even  the  latter  muft  be  iupported  by  a  remaining 
cono-eftion  in  the  blood-veilels. 
MCXLIX. 

That  a  fanguine  effufion  can  happen  without  be- 
.coming  very  fbon  general,  and  thereby  occasioning 
apoplexy  and  death,  may  alfo  feem  doubtful  :  but,  dii- 
fedions  prove  that  in  fad  it  does  happen  occafioning 
palfy  only ;  though  it  is  true,  that  this  more  com- 
monly depends  upon  an  effufion  of  ferous  fluid,  and  of 
-this  only. 

MCL. 

Can  a  palfy,  occaiioned  by  a  compreffion,  remain 
though  the  comprefiion  be  removed*  ? 

MCL1. 

From  what  has  been  faid  MCXLIV.  it  will  be  obvious, 
that  the  hemiplegia  may  be  prevented  by  all  the  feve- 
ral  means  propofed  MCXXV.  et.  feq.  for  the  prevention 
iOf  apoplexy. 

MCLII. 

Upon  the  fame  grounds,  the  CURE  of  palfy  mud  be 
iyery  much  the  fame  with  that  of  apoplexy  (MCXXX. 
et.feq.')',  and  whep  palfy  has  begun  as  an  apoplexy, 
it  is  prefumed,  that,  before  it  is  to  be  confidered  as 
palfy,  all  thofe  feveral  remedies  have  been  employed. 
Indeed,  even  when  it  happens  that  on  the  firft  attack 
of  the  difeafe  the  apoplectic  ftate  is  not  very  complete, 
and  that  the  very  firft  appearance  of  the  difeafe  is  as  a 
hemiplegia,  the  affinity  between  the  two  d'feafes 
.(MCXLIV.)  is  fuch  as  to  lead  to  the  fame  remedies  in 
both  cafes.  This  is  certainly  proper  in  all  thofe  cafes 
in  which  we  can  with  much  probability  impute  the  dif- 

M  2  eafe 

*  This  quefiion  may  be  anfwered  in  the  affirmative  ;  hecaufc  the 
fttufture  of  the  nerve  may  be  deltroyed  by  the  comprtfiion,  and  the 
•nerve  may  therefore  remain  impervious  to  the  newuus  in  uence,  after 
the  compremon  has  been  removed. 


92  PRACTICE 

cafe  to  compreffion  ;  and  it  is  indeed  feldom  that  a 
hemipiegia  from  internal  caufes  comes  on  but  with  a 
confiderable  affection  of  the  internal,  and  even  of  the 
external  fenfes,  together  with  other  marks  of  a  com- 
preilion  of  the  origin  of  the  nerves. 

MCL1II. 

Not  only,  however,  where  the  difeafe  can  be  im- 
puted to  compreffion,  but  even  where  it  can  be  im- 
puted to  the  application  of  narcotic  powers,  if  the  dif- 
eafe come  on  with  the  appearances  mentioned  at  the 
end  of  laft  paragraph,  it  is  to  be'  treated  in  the  fame 
manner  as  an  apoplexy  by  MCXXXI — Mcxxxrx. 

MCL1V. 

The  cure  of  hemipiegia,  therefore,  on  its  fir  ft  at- 
tack, is  the  fame,  or  nearly  the  fa;ne,  with  thai  of  apo- 
plexy :  and  it  feems  requifite  that  it  mould  be  different 
only,  i.  When  the  difeafe  has  fubiifted  for  fome 
time;  2.  When  the  apoplectic  fymptoms,  or  thofe* 
marking  a  confiderable  compreffion  of  the  origi  -  of 
the  nerves,  are  removed  ;  and  particularly,  3.  When 
there  are  no  evident  marks  of  compreffion,,  and  it  i^at 
the  fame  time  known  that  narcotic  powers  have  been 
applied. 

MCLV. 

In  all  thefe  cafes,  the  queftion  arifes,  Whether  fti- 
mulants  may  be  employed,  or  how  far  the  cure  may 
be  entirely  trufted  to  fuch  remedies  ?  Upon  this  qnef- 
tion,  with  rcfpecl  to  apoplexy,  I  have  offered  my  opi- 
nion in  Mcxxxvr.  And,  with  refpecl:  to  hemipiegia, 
I  am  of  opinion,  that  flimulants  are  almoft  always  e^ 
qually  dangerous  as  in  the  cafes  of  complete  apo- 
plexy ;  and  particularly,  i.  In  all  the  cafes  of  hemip- 
iegia fucceeding  to  a  paroxyfm  of  complete  apoplexy  ; 
2.  In  all  the  cafes  coming  upon  perfons  of  the  temper- 
am  mr 

*  The  mod  infallible  of  thefe  marks  is,  the  intelle&ual  faculties 
not  returning. 


O  F     P  H  Y  S  I  C.  93 

ament  mentioned  in  MXCV.  and  after  the  fame  antece- 
dents as  thofe  of  apoplexy,  (MCXVI.)  and  3.  In  all 
the  cafes  coming  on  with  fympLoms  of  apoplexy  from 
compreflion, 

MCLVI. 

It  is,  therefore,  in  the  cafes  MCLI  v,  only,  that  ftimu- 
lants are  properly  admifiible :  And  even  in  the  two 
full  of  thefe  cafes,  in  which  a  plethoric  ftate  of  the 
blood-veflels  of  the  brain  may  have  brought  on  the 
difeafe,  in  which  a  difpofitiontothat  ftate  may  (till  conti- 
nue, and  in  which  even  fome  degree  of  congeftion  may 
Hill  remain,  the  ufe  of  ftimulants  mufl  be  an  ambiguous 
remedy  ;  fo  that  perhaps  it  is  in  the  third  of  thefe  cafes 
only  that  ftimulants  are  clearly  indicated  and  admiffible. 
MCLViL 

Thefe  doubts  with  refpeft  to  the  ufe  of  ftimulants, 
may  perhaps  be  overlooked  or  difregarded  by  thofe 
whoalledge  that  ftimulants  have  been  employed  with 
advantage  even  in  thofe  cafes  (MCLV.)  in  which  I 
have  faid  thev ought  to  be  avoided. 
MCLVIII. 

To  compromife  this  contrariety  of  opinion,  I  muft 
obferve,  that  even  in  the  cafes  of  hemiplegia  depend- 
ing upon  compreffion,  although  the  origin  of  the  nerves 
be  fo  much  coirs preiTed  as  to  pi-event  fo  full  a  flow  of 
the  nervous  power  as  •$  neceflUry  to  mufcular  motion, 
yet  it  app-  v.rs  from  the  y-  ,wer  of  fenfe  ft  ill  remaining, 
thnt  the  nerves  are,  to  a  cor'ain  degree,  ftill  previous ; 
and  therefore  it  is  probable  that  ftimulants  applied, 
may  excite  the  energy  of  the  brain  fo  much,  as  in 
fome  me af Lire  to  force  open  the  comprerTed  nerves, 
and  to  fiiow  fome  return  of  motion  in  paralytic  muf- 
cles.  Nay,  further,  it  may  be  allowed,  that  if  thefe 
ftimulants  be  fuch  as  acl  more  upon  the  nervous  than 
Mpon  the  fanguiferous  fyftem,  they  may  p  -flibly  be 
employed  without  any  very  hurtful  confequence. 

MCLIX. 


94  PRACTICE 

MCLIX. 

But  fill!  it  will  be  obvious,  that  although  certain 
ilimulants  act  chiefly  upon  the  nervous  fyilem,  yet 
they  alfo  act  always  in  forne  meafure  upon  the  fangui- 
ferous ;  fo  that,  when  they  happen  to  have  the  latter 
effect  in  any  conilderable  degree,  they  may  certainly 
do  much  harm;  and  in  a  diiede  which  they  do  not 
entirely  cure,  the  rnifchief  arifing .  from  them  may 
not  be  difcerned. 

MCLX. 

Whilft  the  employment  of  ftimulants  is  fo  often  an 
ambiguous  praclice,  we  may  perhaps  go  fome  length 
towards  afcertaining  the  matter,  by  confidering  the 
nature  of  the  feveral  ftimulants  which  may  be  employ- 
ed, and  fome  of  the  circumftances  of  their  adminiflra- 
tion.  TvVith  this  view  therefore,  I  fhall  now  mention 
the  fever al  ftimulants  that  have  been  commonly  em- 
ployed, and  offer  fome  remarks  upon  their  nature  and 
life. 

MCLXI. 

They  are  in  the  firft  place  to  be  diftingnifhed  as  ex- 
ternal or  internal.  Of  the  firil  kind,  we  again  diftin- 
guith  them  as  they  are  applied  to  particular  parts  of 
the  body  only,  or  as  they  are  more  generally  appLed 
to  the  whole  fyftem.  Of  the  firfl  kind  are, 

i.  The  concentrated  acids  of  vitriol  or  nitre ;  in- 
volved, however,  in  oily  or  un&ious  fubftances,  which 
may  obviate  their  corrofive,  without  deflroying  their 
ftimulant  power*. 

-  2.  The 

*   Rubefaoient  ointments  arc  competitions  like  the  following  : 
§,.  Axung.  porcin.  %n. 
Acid  vitriol.  3'- 
M. 

Or, 

$?.  Unguent,  bafilic.  flav.  lii. 
.Acid  vitriol,  gi. 
M. 
Thev  foon  reJdcn  and  inflame  the  fkin  ;  and,  when  this  efFe^fi  is  pro- 


OF    PHYSIC.  95 

2.  The  volatile  alkaline  fpirits,  efpecially  In  their 
cauftic  ftate  ;  but  involved  alib  in  oils,  for  the  purpofe 
juft  now  mentioned*. 

3.  The  fame  volatile  fpirits  are  frequently  employ- 
ed by  being  held  to  the  nofe,  when  they  prove  a  pow- 
erful ilimulus  to  the  nervous  fyftem ;    but  it  is  at  the 
fame  time  probable,  that  they  may  alfo  prove  a  ftrong 
ftimulant  to  the  blood -vefiels  of  the  brain. 

4.  A  brine,  or  ftrong  folution  of  fea-faltf . 

5.  The  eflential  oils  of  aromatic  plants  J,  or  of  ibeir 
parts. 

6.  The  eflential  oils  of  turpentine,  or  of  other  fuch 
refinous  fubftances. 

7.  The  diflilled  oils  of  amber,  or  of  other  bitumin- 
ous fo  flils  §. 

8.  The  rectified  empyreumatic  oils  of  animal  or  ve- 
getable fubftances  || . 

9.  Va- 

duced,  they  mud  be  taken  off,  and  the  part  anointed  with  common 
ointment,  or  with  oil. 

*  The  Linimenta  volatilia  of  the  Pharmacopoeias  are  not  fo  ftrong 
as  the  following  : 

£>.  Alkal.  volatil.  cauftic  |i. 
Ol.  olivar,  gii, 
M. 

In  the  new  London  Pharmacopoeia  this  competition  is  called  L> 
rmnentum  Ammoniac  Fortius. 

f  The  brine  that  remains  in  the  falt^pans,  after  the  common  fait 
is  cryftalized,  is  the  moft  effectual  of  thcfe  briny  ftimulants  ;  it  is 
called  in  Edinburgh  Oil  of  Salt. 

f  The  OI.  Origani  is  generally  ufed.       It  otight  to  be  mixed  with 
fome  unduous  oil,  as  in  the  following  formula  : 
&.  Ol    Origan.  3!!. 
Axung.  porcin.  giv. 

M; 

The  aromatic  oils  di(Folved  in  fpirits  make  an  elegant  application  ; 
but  thediftilled  fpirits  of  the  plants  themfelves  ?re  more  in  ufe. 

§  They  are  generally  ufed  with  hog's-lanl,  in  the  proportion  of 
eight  times  their  quantity  of  lard.  Some  practitioners,  however, 
take  only  twice  the  qviantity  of  lard  ;  but  they  are  not  fo  effectual 
as  fome  of  the  rubefacienf?  above  enumerated, 

{]   The  ufe  of  thefe  empyreumatic  oils  is  not  fo  frequent  now  a* 


S>6'  PRACTICE 

9.  Various  vegetable  acrids,  particularly  muftard*. 

10.  The  acrid  matter  found  in  feveral  infects,  par- 
ticularly can  thar  ides  f . 

Some  of  thefe  flimulants  may  be  either  applied  in 
fubftarice ;  or  may  be  diiTolved  in  ardent  fpirits,  by 
which  their  flimulant  power  may  be  increafed,  or 
more  conveniently  applied. 

MCLXII. 

The  greater  part  of  the  fubiiances  now  enumerated 
fhow  their  ftimulant  power  by  inflaming  the  fkin  of 
the  part  to  which  ihey  are  applied  ;  and  when  their 
application  is  fo  long  continued  as  to  produce  this  ef- 
fect ;  it  interrupts  the  continuance  of  their  ufe  ;  and 
the  inflammation  of  the  part  does  not  feem  to  do  fo 
much  good  as  the  frequent  repetition  of  a  more  mode- 
rate ftimulus. 

MCLXIII. 

Analogous  to  thefe  (limulants  is  the  flinging  of  net- 
tles, which  has  been  frequently  recommended. 

Among  the  external  ilimulants,  the  mechanical  one 
of  friction  with  the  naked  hand,  the  flefh-brufh,  or 
flannel,  is  juflly  to  be  reckoned.  Can  the  impregna- 
tion of  the  flannels  to  be  employed,  with  the  fumes 
of  burning  maflic,  olibanuni,  &c.  be  of  any  fervicef  ? 

MCLXV. 

formerly;  they  are  extremely  acrid,  and  if  not  ufed  with  caution, 
often  corrode  the  fkin 

*  The  form,  ih  which  the  flour  of  muftard  is  ufed,  is  called  a  fi- 
napifm.  it  is  mixed  with  an  equal  quantity'of  bread-crumb  or  oat- 
meal, and  made  into  a  paile  with  vinegar.  Some  practitioners  add 
bruifed  garlic,  in  tlis  proportion  of  one  fourth  of  the  quantity  of  mu- 
liard  ;  but  it  is  extremely  otTeniiw,  and  the  cataplafiu  without  it  an- 
fwers  fofficicntly  well. 

•j-   Thefe  infects  are  the  bafis  of  bHHering  plaflersand  ointments. 

J  Many  practitioners  have  thought  Ui-r  <\ich  impregnations  have 
been  of  fm^ular  fcrvice.  The  fumes  of  iv.o!l  of  thefe  refins  are  ei- 
ther flowers,  as  th'*y  are  celled  in  the  fri^r  .  or  e'feutial  oils,  Loth 
of  which  ire  Rimulating,  and  may  tlierefore  be  fuppofed  to  be  active. 

Tlic  impregnating  flannels  or  ficfli-brulhes  with  flour  of  oiuflard  is 
often  ufrd,  and  afliftsconliderably  in  bringing  on  an  inflammation. 


OF      PHYSIC.  97 

MCLXIV. 

With  refpecl:  to  the  whole  of  thefe  external  ftimu- 
lanrs,  it  is  to  be  obferved,  that  they  affed:  the  part  to 
which  they  are  applied  much  more  than  they  do  the 
whole  fyftem,  and  they  are  therefore  indeed  fafer  in 
ambigu*  us  cafes;  but,  for  the  fame  reafon,  they  are 
of  lefs  efficacy  in  curing  a  general  affe&ion. 
MCLXV. 

The  external  applications  which  may  be  applied  to 
affect  the  whole  fyltem,  are  the  powers  of  heat  and 
col.i,  and  of  electricity. 

Heat,  as  one  of  the  moft  powerful  flimulants  of  the 
animal  ceconomy,  has  been  often  employed  in  palfies, 
efpecially  by  warm  bathing.  But  as,  both  by  fiimu- 
lating  the  iblids  and  rarefying  the  fluids,  this  proves  a 
ftrong  ftimulus  to  the  fanguiferous  fyftem,  it  is  often 
an  ambiguous  remedy  ;  tind  has  frequently  been  ma- 
nifeitly  hurtful  in  palfies  depending  upon  a  congeftion 
of  blood  in  the  verfels  of  the  brain.  The  moft  certain, 
and  therefore  the  moft  proper  ufe  of  warm  bathing 
in  palfies,  feems  to  be  in  thofe  that  have  been  occafi- 
oned  by  the  application  of  narcotic  powers.  Are  the 
natural  baths  more  ufeful  by  the  matters  with  which 
they  may  be  naturally  impregnated*. 
MCLXVI. 

Cold  applied  to  the  body  for  any  length  of  time,  is 
always  hurtful  to  paralytic  perfons  :  but  if  it  be  not 
very  intenfe,  nor  the  application  long  continued,  and 
if  at  the  fame  time  the  body  be  capable  of  a  briik  reac- 

VOL.  II.  N  ticn, 

*  The  natural  baths  contain  fo  fmall  a  quantity  of  impregnating 
fubftances  as  induces  us  to  lufpeft  that  they  cannot  kave  any  benefi- 
cial powers  fuperior  to  thofe  of  ordinary  warm  baths. 

The  ufe  of  warm  baths  ought  not  to  be  promifcuous.  In  cafes  of 
palfies,  arifing  from  certain  poifons,  as  the  fumes  of  arfenic  or  metals, 
and  their  ores  ;  the  warm  baths  feldom  fail  of  procuring  relief;  and 
fome  inftances  have  been  given  by  authors,  of  complete  cures  having 
been  performed  by  the  ufe  of  baths  alone. 


$8  P  R  A  -C  T  I  C  E 

tion,  fuch  an  application  of  cold  is  a  powerful  flimrr* 
lant  of  the  whole  fyftem,  and  has  often  been  ufeful  in 
curing  palfy.  But,  if  the  power  of  reaction  in  the  bo- 
dy be  weak,  any  application  of  cold  may  prove  very 
hurtfulf. 

MCLXVII. 

Eleftricity,  in  a  certain  manner  applied,  is'eertain- 
ly  one  of  the  moil  powerful  fthnulants  that  can  be  em- 
ployed to  act  upon  the  nervous  fyftein  of  animals; 
and  therefore  much  has  been  expected  from  it  in  the 
cure  of  palfy.  But,  as  it  ftimulates  the  fanguiferous 
as  well  as  the  nervous  fyftem,  it  has  been  often  hurt- 
ful in  palfies  depending  upon  a  comprefli  >n  of  the 
brain  ;  and  efpecially  when  it  has  been  fo  applied  as 
to  aft  upon  the  vefTels  of  the  head.  It  is  fafer  when 
its  operation  is  confined  to  particular  parts  fomewhat 
remote  from  the  head  ;  and,  further,  as  the  operation 
of  electricity,  when  very  ftrong,  candeftroy  the  mobi- 
lity of  the  nervous  power.  I  am  of  opinion,  that  it 
is  always  to  be  employed  with  cauiion,  and  that  it  is 
only  fafe  when  applied  with  moderate  force,  and  when 
confined  to  certain  parts  of  the  body  remote  from  the 
head.  It  is  alfo  my  opinion,  that  its  good  effects  are 
to  be  expected  from  its  repetition  rather  than  from 
its  force,  and  that  it  is  particularly  fuited  to  the  cure 
of  thofe  palfies  which  have  been  produced  by  the  ap- 
plication of  narcotic  powers. 

MCLXVIII. 

Amongft  the  remedies  of  palfy,  the  tife  of  exercife 
is  not  to  be  omitted.  '  In  a  hemiplcgia,  bodily  exer- 
cife cannot  be  employed  ;  and  in  a  more  limited  af- 
fection, if  depending  upon  a  compreffion  of  fame  part 
of  the  brain,  it  would  be  an  ambiguous  remedy  ;  but, 

in 

*  The  very  great  uncertainty  of  the  power  of  rea&ion  always 
makes  the  application  of  cold  a  very  doubtful  remedy  ;  and,  as  it  is 
evidently  hurtful,  wherever  the  rea&fon  is  weak,  it  ought  to  be  ufod 
with  extreme  caution, 


OF    P  JH  Y  S  I  Q,  99 

*$  all  cafes  where  the  exercifes  of  geftation  can  be  em- 
pjoyed,  they  are  proper  ;  as,  even  in  cafes  of  compref- 
lion,  the  itimulus  of  fuch  exercife  is  moderate,  and 
therefore  fafe ;  and,  as  it  always  determines  to  the 
furface  of  the  body,  it  is  a  remedy  in  all  cafes  of  in- 
t£rnal  congcftion. 

MCLXIX. 

The  internal  ftirnukms  employed  in  palfy  are  vari- 
ous, but  chiefly  the  following. 

1.  The  volatile  alkaline  falts,  or  fpirits,  as  they  are 
called,  are  very  powerful  and  diuufi.ve  flimulanu,  ope- 
rating efpecialiy  on  the  nervous  fyfteni*;  and  even  al- 
though they  operate  on  the  fanguife.ro.us,  yet,  ifrgiven 
in  frequently  repeated  fmall  rather  than  in  large  dofes, 
their  operation  being  tranfitory,  is  tolerably  fare. 

2.  The  vegetables  of  the  clafs  named  Tetradyna? 
niia,  are  many  of  them  powerful  diifufive  flimulants  ; 
and  at  the  fame  time,  as  quickly  palling  out  of  the  bo- 
dy, and  therefore  of  tranlitory  operation,  they  are  of- 
ten employed  with  fafetyf .     As  they  commonly  prove 
diuretic,  they   may  in  this  way  alfo  Up  of  fervice  in 
fome  cafes  of  ferous  palfy. 

N  2  3.  The 

*  Of  tliefe  there  are  feveral  formulae  in  the  (hops,  as,  Spiritus  vo- 
latilis  aromaticus,  Spiritus  volatilis  oleofus,  Spiritus  falinus  aromati- 
cus.  Their  dofe  is  from  ten  to  fixty  drops.  The  Eau  de  Luce 
ought  to  be  mentioned  here,  though  it  isfeldom  ufed  internally,  hut 
only  for  fmelling  to,  as  it  is  extremely  penetrating.  It  is  prepared 
thus  :  mix  together  in  a  retort  forty  drops  of  reified  oil  of  amher, 
an  ounce  of  reftified  fpirit  of  wine,  and  twelve  ounces  of  the  ftrong- 
eft  cauftic  volatile  alkali.  Theymuft  be  diililled  with  a  very  mode- 
rate fire.  It  is  feldom  limpid,  but  has  a  milky  appearance,  owing  to 
the  imperfec"l  folution  of  the  oil  in  the  fpirit ;  and,  if  the  alkali  be 
not  very  cauitic,  fcarcely  any  of  the  oil  is  diffolved. 

f  White  muftard-feeds  may  be  given  whole,  in  the  quantity  of  two 
tea-fpoonfuls  in  half  a  tea-cupful  of  cold  water.  They  ought  to  be 
fwallowcd  whole,  that  their  acrid  tafte  may  not  be  perceived.  The 
dofe  may  be  repeated  twice  or  thrice  a-day.  -Horfe-radifh  is  another 
piant  of  this  clafs  of  vegetables,  that  has  been  much  recommended  ; 
it  mufi  be  given  in  a  cold  watery  infufion,  or  in  an  in.fwfion  of  ale. 


ioo  PRACTICE 

3.  The  various  aromatics,  whether  employed  in 
fubftance,  in  tincture,  or  in  their  effential  oils,  are  of.  * 
ten  powerful  ftimulants ;  but  being  more  adheilve  and 
inflammatory  than  thofe   laft  mentioned,    they    are 
therefore,  in  all  ambiguous  cafes,  lefs  fafe*. 

4.  Some  other  acrid  vegetables  have  been  employ- 
ed ;  but  we  are  not  well  acquainted  with  their  peculiar 
virtues,  or  proper  life. 

g.  Some  reiinous  fubitances,  as  guaiacum,  and  the 
terebinthinate  fubflanccs,  or  their  effential  oils,  have 
been,  with  fome  probability,  employed  ;  but  they  are 
apt  to  become  inflammatory.  Deceptions  of  guaia- 
cum, and  fome  other  fudorifics,  have  been  directed  to 
excite  fweating  by  the  application  of  the  fumes  of 
burning  fpirit  of  wine  in  the  laconicum,  and  have  in 
that  way  been  found  ufeful. 

6.  Many  of  thefetid  antifpafmodic  medicines  have 
been  frequently  employed  in  palfy ;  but  I  do  not  per- 
ceive in  what  manner  they   are  adapted  to  the  cure 
of  this  difede,  'and  I  have  not  obferved  their  good  ef- 
fects in  any  cafes  of  it. 

7.  Bitters,  and  the  Peruvian  bark,   have  alfo  been 
employed  ;  but  with  no  propriety  or  advantage  that  I 
can  perceivef . 

MCLXX. 

The  fcurvy^grafs  is  another  of  the  fame  clafs  ;  it  may  be  eaten  raw, 
or  we  may  give  foi  ty  or  fifty  drops  of  the  Spit  Jtus  cochleariae,  either 
on  a  piece  of  fugar,  or  mixed  with  half  an  ounce  of  fyrup,  four  or 
five  times  a-day.  Tin's  fpirit  ought  to  be  kept  well  corked,  as  it 
foon  lofes  its  activity,  if  it  be  expofed  to  the  air. 

*  The  aromatics  beil  adapted  for  ftimulating,  in  thefe  cafes,  are 
fuch  as  Linne  calls  fpirantia  ;  the  chief  of  them  are  Marum,  Rofema- 
ry,  Lavender,  &c.  Their  fpiritous  waters  are  much  more  effica- 
cious than  the  plants  in  fubflance,  or  in  any  other  form  ;  and  their 
efficacy  is  confiderably  increafed  by  uniting  them  to  volatile  fpirits, 
as  in  fome  of  the  formulae  mentioned  in  the  note  on  par.  1 169,  1.  6, 
at  the  word  fyftem. 

f  In  fome  cafes,  paralytic  patients,  for  want  of  exercife,  fink  in- 
to a  ft  ate  of  debility,  with  lofs  of  appetite,  and  confequent  emacia- 


O  F    P  H  Y  S  I  C.  10? 

MCLXX. 

With  refpeft  to  the  whole  of  thefe  internal  flimu- 
lants,  it  is  to  be  obferved,  that  they  ieklom  prore  very 
powerful  5  and  wherever  there  is  any  doubt  concern- 
ing the  nature  or  ft  ate  of  the  difeafo,  they  may  readi- 
ly do  harm,  and  are  often  therefore  of  ambiguous  ufe. 


BOOK        II. 

OF     A  D  Y  N  A'M  I  JE  ; 

O  R. 

DISEASES  CONSISTING  IN  A  WEAKNESS  OR 

LOSS  OF  MOTION  IN   EITHER  THE  VITAL 

OR   NATURAL   FUNCTIONS. 

CHAP.       I, 

OF  SYNCOPE  OR  FAINTING. 

MCLXXI. 

THIS  is  a  difeafe  in  which  the  action  of  the  heart 
and   refpiration  become    confiderably    weaker 
than  ufual,  or  in  which  for  a  certain  time  thefe  func- 
tions ceafe  altogether. 

MCLXXII. 

Phyiicians  having  obferved  that  this  afFeclion  oc- 
curs in  different  degrees,  have  endeavoured  to  diftin- 
guifh  thefe  by  different  appellations  :  but  as  it  is  not 
poffible  to  afcertain  thefe  different  degrees  with  any 

preciiion, 

tion,  In  which  bitter*,  penman  bark,  and  other  tonics,  are  frequently 
of  fome  advantage, 


io2  PRACTICE 

precifion,  fo  there  can  be  no,ftric~i  propriety  in  em- 
ploying thofe  different  names ;  and  I  {hall  here  com- 
prehend the  whole  of  the  affedions  of  this  kind  un- 
der the  title  of  Syncope. 

MCLXXIII. 

This  difeafe  fometimes  comes  on  fuddenly  to  a  con- 
fiderable  degree,  but  fometimes  alfo  it  comes  on  gra- 
dually; and  in  the  latter  cafe,  it  ufually  comes  on 
with  a  fenfe  of  langour,  and  of  anxiety  about  the 
heart,  accompanied  at  the  fame  time,  or  immediately 
after,  with  fome  giddinefs,  dimnefs  of  fight,  and  found- 
ing in  the  ears.  Together  with  thefe  fymptoms,  the 
pulfe  and  refpiration  become  weak ;  and  often  fo  weak, 
that  the  pulfe  is  fcarccly  to  be  felt,  or  the 'refpiration 
to  be  perceived  ;  and  fometimes  thefe  motions,  for  a 
certain  time,  ceafe  altogether.  While  thefe  fymp- 
toms take  place,  the  face  and  whole  fuiface  of  the  bo- 
dy become  pale,  and  more  or  lefs  cold  according  to 
the  degree  and  duration  of  the  paroxyfm.  X^ery 
commonly,  at  the  beginning  of  this,  and  during  its 
continuance,  a  cold  fweat  appears,  and  perhaps  conti- 
nues, on  the  fore-head,  as  well  as  on  fome  other  parts 
of  the  body.  During  the  paroxyfms,  the  animal 
functions,  both  of  fenfe  and  motion,  are  always  in  fome 
degree  impaired,  and  very  often  entirely  fufpendcd. 
A  paroxyiVn  of  fyncope  is  often,  after  fome  time,  fpon- 
taneoufly  recovered  from ;  and  this  recovery  is  gene- 
rally attended  with  a  fenfe  of  much  anxiety  about  the 
heart. 

Fits  of  fyncope  are  frequently  attended  with,  or  end 
in,  vomiting  ;  and  fometimes  with  convulfions,  or  an 
epileptic  fit. 

MCLXXIV. 

Thefe  are  the  phenomena  in  this  difeafe ;  and  from 
every  view  of  the  greateflparc  of  them,  there  cannot 
be  a' doubt  that  the  proximate  caufe  of  this  difeafe  is 
a  very  weak  or  a  total  ceaiing  of  the  adion  of  the 

heart. 


o  F  p  n  Y  s  r  a  io3 

heart.  But  it  will  be  a  very  difficult  matter  to  explain 
in  what  manner  the  fevcral  remote  caufes  operate  in 
producing  the  proximate  caufe.  This,  however,  I 
ihail  attempt,  though  with  that  diffidence  which  be- 
comes me  in  attempting  a  fubject  that  has  not  hither- 
to been  treated  with  much  fuccefs. 
MCLXXIVf. 

The  remote  caufe  of  fyncope  may,  in  the  firft  place, 
be  referred  to  two  general  heads.  The  one  is,  of 
thofe  caufes  'exifting  and  acting  in  the  brain,  or  in 
parts  of  the  body  remote  from  the  heart,  but  acting 
upon  it.  by  the  intervention  of  the  brain.  The  other 
general  head  of  the  remote  caufes  of  fyncope,  is  of 
thofe  exilting  in  the  heart  itfelf,  or  in  parts  very  im- 
mediately connected  with  it,  and  thereby  acting  more 
directly  upon  it  in  producing  this  difeafe. 
MCLXXV, 

In  entering  upon  the  coniideration  of  the  firfl  fet  of 
thofe  caufes  (MCLXXIV.),  I  muft  affume  a  proportion 
which  I  fuppofe  to  be  fully  eftablimed  in  phyfiology. 
It  is  this  :  That,  though  the  mufcular  fibres  of  the 
heart  be  endowed  with  a  certain  degree  of  inherent 
power,  they  are  dill,  for  fuch  action  as  is  necefiary  to 
the  motion  of  the  blood,  very  conftantly  dependent 
upon  a  nervous  power  fent  into  them  from  the  brain  J. 
At  leaft  this  is  evident,  that  there  are  certain  powers 
acting  primarily,  and  perhaps  only  in  the  brain,  which 
influence  and  variouily  modify  the  action  of  the  heart. 

I 


•f  The  Paragraphs  were  thus  numbered  in  the  laft  edition. 

$  The  author  here  differs  fomewhat  in  opinion  from  other  phyfic- 
logifts.  He  allows,  indeed,  that  the  heart  poffeifes  a  vis  infita  in  a 
certain  degree,  ;  but  he  will  not  allow  this  vis  infita  to  be  fuffieient- 
ly  rtrong  for  carrying  on  the  circulation  ;  and  he  thinks  that  fome 
energy  mud  be  imparted  to  the  heart  from  the  brain,  in  order  to  en- 
able that  important  mufcle  feo  perform  its  office. 

In  fupport  of  this  opinion,  we  have  a  plain  fa£t,  which  the  author 
might  have  adduced,  viz.  that  a  ligature  on  the  nerves  going  to  the 
keart  immediately  Hops  its  motions. 


io4  PRACTICE 

I  fuppofe,  therefore,  a  force  very  conftantly  during 
life  exerted  in  the  brain,  with  refpect  to  the  moving 
fibres  of  the  he  ut,  as  well  as  of  every  part  of  the  body  ; 
which  fbrce  I  fhall  call  the  energy  of  the  brain  ;  and 
which  I  fuppofe  may  be,  on  different  occafions,  ilrong- 
er  or  weaker  with  reipecl  to  the  heart. 

MCLXXVI. 

Admitting  thefe  proportions,  it  will  be  obvious, 
that  if  I  can  explain  in  what  manner  the  firft  fet  of 
remote  caufes  (MCLXXIV.)  diminifh  the  energy  of  the 
brain,  I  ihall  at  the  fame  time  explain  in  what  manner 
thefc  caufes  occaiion  a  fvncope. 

MCLXXVII. 

To  do  this,  I  obferve,  that  one  of  the  moil  evident 
of  the  remote  caufes  of  fyncope  is  a   hemorrhagy,   or 
an  evacuation  of  blood,  whether  fpontaneous  or  artifi- 
ciai.      And  as    it  is  very  manifeft  that  the  energy  of 
the  brain  depends  upon  a  certain  fulnefs  and  tenflon 
of  its  blood-veffels,  for  which  nature  feems  to  have  in- 
duftriouily  provided  by  fuch  a  conformation  of   thofe 
blood-veiFels  as  retards  the  motion  of  the  blood  both 
in  the  arteries  and  veins  of  the  brain  ;  fo  we  can  rea- 
dily perceive,  that  evacuations  of  blood,  by  taking  off 
the  fullnefs  and   tcnfion  of  the  blood-verTels  of  the 
brain,  and  thereby  diminifhing  its  energy  with  refpect 
to  the  heart,  rmy  occaiion  a  iyncope.     In  many  per- 
fons  a  fmall  evacuation  of  blood  will  have  this  effect ; 
and  in  fuch  cafes  there  is  often  a  clear  proof  of  the 
manner  in  which  the  caufe  operates,  from  this  circum- 
ftance,    that  the  effect  can  be  prevented  by  laying  the 
body  in  a  horizontal  pofturc  ;  which,  by  favouring  the 
afflux  of  the  blood  by  the  arteries,  and  retarding  the 
return  of  it  by  the  veins,   preferves  the  neceflary  ful- 
nefs of  the  veflels  of  the  brain. 

It  is  farther  to  be  remarked  here,  that  not  only  an 
evacuation  of  blood  occafions  fyncope,  but  that  even  a 
change  in  the  diftribution  of  the  blood,  whereby  a 

larger 


OF    PHYSIC.  105 

larger  portion  of  it  flows  into  one  part  of  the  fyftem 
of  blood-veffels,  and  confequently  lefs  into  others, 
may  occafion  a  fyncope.  It  is  thus  I  explain  the  fyn- 
cope that  readily  occurs  upon  the  evacuation  of  hy- 
dropic waters,  which  had  before  filled  the  cavities  of 
the  abdomen  or  thorax.  It  is  thus  alfo  I  explain  the 
fyncope  that  fometimes  happens  on  blood-letting,  but 
which  does  not  happen  till  the  ligature  which  had  been 
employed  is  united,  arid  admits  a  larger  afHux  of  blood 
into  the  blood-veffels  of  the  arm.  Both  thcfe  cafes  of 
fyncope  ihovv,  that  :m  evacuation  of  blood  does  not 
always  occafion  the  difcafe  by  any  general  effect  on 
the  whole  fyftem,  but  often  merely  by  taking  off  the 
requifite  fuinefs  of  the  blood -veffcls  of  the  brain. 

MCL  xxviii. 

The  operation  of  fome  others  of  the  remote  caufes 
of  fyncope,  may  be  explained  on  the  following  princi- 
ples. Whilft  the  energy  of  the  brain  is,  upon  differ- 
ent occaiions,  nianifeftly  flronger  or  weaker,  it  feems 
to  be  with  this  condition,  that  a  flronger  exertion  of  it  is 
neceffarily  followed  byaweakerflateof  the  fame,  it  feems 
to  depend  upon  this  law  in  the  conilitution  of  the  ner- 
vous power,  that  the  ordinary  contraction  of  a  mufclc 
is  always  alternated  with  a  relaxation  of  the  fame  ; 
that,  unlefs  a  contraction  proceeds  to  the  degree  of- 
fpafm,  the  contracted  flate  cannot  be  long  continued  ; 
and  it  feems  to  depend  upon  the  fame  caufe  that  the 
voluntary  motions,  which  always  require  an  unufual 
increafe  of  exertion,  and  occafion  fatigue,  debility,  and 
at  length  irrefiftible  fleep. 

From  this  law,  therefore,  of  the  nervous  power,  we 
may  underfland  why  a  fudden  and  violent  exertion 
of  the  energy  of  the  brain  is  fometimes  followed  by 
ftich  a  diminution  of  it  as  to  occafion  a  fyncope-;  and 
it  is  thus  I  fuppofe  that  a  violent  fit  of  joy  produces 
fyncope,  and  even  death.  It  is  upon  the  fame  princi- 
ple alfo,  I  fuppofe,  that  an  exquifite  pain  may  fome- 
times excite  the  energy  of  the  brain  more  ftrongly 

VOL.  II.  O  than 


106  PRACTICE 

than  can  be  fupported,  and  is  therefore  followed  by 
fuch  a  diminution  as  mud  occafion  fainting.  But 
the  effecl:  of  this  principle  appears  more  clearly  in 
this,  that  a  fainting  readily  happens  upon  the  fuclden 
remiflion  of  a  confiderable  pain  ;  and  thus  I  have  feen 
a  fainting  occur  upon  the  reduction  of  a  painful  diflo- 
cation. 

MCLXXIX. 

It  feems  to  be  quite  analogous  when  a  fyncope  im-. 
mediately  happens  on  the  finifhing  of  any  great  and 
long-continued  effort,  whether  depending  on  the  will, 
or  upon  a  propenfity  ;  arid  in  this  way  a  fainting 
fometimes  happens  to  a  woman  on  the  bearing  of  a 
child.  This  may  be  well  illuftrated  by  obferving,  that 
in  perfons  already  much  weakened,  even  a  very  mode- 
rate effort  will  fometimes  occafion  fainting. 
MCLXXX. 

To  explain  the  operation  of  fome  other  caufes  of 
fyncope,  it  may  be  oblerved,  that  as  the  exertions  of 
the  energy  of  the  brain  are  efpecially  under  the  influ- 
ence of  the  will,  fo  it  is  well  known  that  thofe  modifi- 
cations of  the  will  which  are  named  Pailions  and  Emo- 
tions, have  a  powerful  influence  on  the  energy  of  the 
brain  in  its  acHons  upon  the  heart,  either  in  increafing 
or  diminiming  the  force  of  that  energy.  Thus,  anger 
has  the  former,  and  fear  the  latter  effect, ;  and  thence' 
it  may  be  underilood  how  terror  often  occafions  a  fyn- 
cope fometimes  of  the  moft  violent  kind,  named  Af- 
phyxia,  and  fometimes  death  itfeJf. 
MCLXXXL 

As,  from  what  I  have  j oft  mentioned,  it  appears, 
that  the  emotions  of  defire  increafe,  and  thofe  of  aver- 
fion  diminifh,  the  energy  of  the  brain  ;  fo  it  may  be 
undeaiood,  how  a  ftrong  averfion,  a  horror,  or  the 
feeling  which  arifes  upon  the  light  of  a  very  difagreea- 
•ble  object,  may  occafion  fainting.  As  an  example  of 
this,  I  have  known  more  than  one  inftance  of  a  perfon's 
fainting  at  the  fight  of  a  fore  in  another  perfon. 

MCLXXXIL 


OF    PHY  SI  C.  107 

MCLXXXII. 

To  this  head  of  horror  and  difgiifi:,  I  refer  the  ope- 
ration of  thofe  odours  which  in  certain  perfons  occa- 
lion  fyncope.  It  may  be  i'upp  ofcd,  that  thofe  odours 
are  endowed  with  a  directly  iedative  power,  and. may 
thereby  occafion  fyncope;  but  they  are,  many  of  them, 
with  refpect  to  adher  perlbns,  evidently  of  a  contrary 
quality;  audit  apprars  to  nifc,  <ie  odours  occa- 

lion  fyncope  only  in  thofe  pedbas  to  whom  they  are 
extremely  disagreeable. 

MCLXXXIIL 

It  is,  however,  very  probable,  that  among  the  cauf- 
;cs  of  fyncope,  there  are  f -me  which,  analogous  to  all 
thofe  we  have  already  mentioned,  act  by  a  directly  fe- 
dative  power:  ar.d  fuch  may  either  be  ditfufed  in  the 
mafs  of  bipod,  and  thereby  communicated  to  the 
brain;  or  may  be  only  taken  into  the  ftomach,  which 
fo  readily  and  frequently  communicates  its  affections 
to  the  brain. 

MGLXXXIV. 

Having  now  enumerated,  and,  as  I  hope,  explained, 
the  molt  part  of  the  remote  caufes  of  fyncope,  that 
cither  o'perate  immediately  upon  the  brain,  or  whofe 
operation  upon  other  parts  of  the  body  is  communi- 
cated to  the  brain,  it  is  proper  to  obferve,  that  the 
mod  part  of  thefe  caufes  operate  upon  certain  perfons 
more  readily  and  more  powerfully  than  upon  others  5 
and  this  circumitance,  which  may  be  confidered  as  the 
predifponent  caufp  of  fyncope,  defc^es  to  be  inquired 
into. 

It  is,  in  the  firfl  place,  obvious,  that  the  operation 
of  fome  of  thofe  caufes  depends  entirely  upon  an  idio- 
fyncrafy  in  the  perfons  upon  whom  they  operate  ; 
which,  however,  I  cannot  pretend  to  explain.  But, 
in  the  next  place,  with  rcfpect  to  the  greater  part  of 
the  other  caufes,  their  effects  feern  to  depend  upon  a 
temperament  which  is  in  one  degree  or  other  in  com- 

O  2  mon 


io8  PRACTICE 

mon  to  many  perfons.  This  temperament  feenis  to 
confift  in  a  great  degree  of  fenfibility  and  mobility, 
arifing  from  a  flate  of  debility,  ibmetLues  depending 
upon  original  conformation,  and  fometimes  produced 
by  accidental  occurrences  in  the  courfe  of 
MCLXXXV. 

The  fecond  fet  of  the  remote  caufes  of  fyncope 
(MCLXXIV.),  or  th  >fe  acting  directly  upon  the  heart 
itfelf,  are  certain  organic  affections  of  the  heart  itfelf, 
or  of  the  parts  immediately  connected  with  it,  parti- 
cularly the  great  veflels  which  pour  blood  into  or 
immediately  receive  it  from  the  cavities,  of  the  heart. 
Thus  a  dilatation  or  aneurifm  of  the  heart,  a  polypus 
in  its  cavities,  abfceiTes  or  ulcerations  in  its  fubftance, 
a  clofe  adherence  of  the  pericardium  to  the  furface  of 
the  heart,  aneurifms  of  the  great  veflels  near  to  the 
heart,  polypus  in  thefe  j  and  offiflcations  in  thefe  or  in 
the  valves  of  the  heart,  are  one  or  other  of  them  condi- 
tions which,  upon  diffecTiion,  have  been  difcovered  in. 
thofe  perfons  who  had  before  laboured  under  frequent 
fyncope. 

MCLXXXVI. 

It  is  obvious,  that  thefe  conditions  are  all  of  them, 
either  fuch  as  may,  upon  occafion,  diflurb  the  free  and 
regular  influx  into,  or  the  free  egrefs  of  the  blood 
from,  the  cavities  of  the  heart;  or  fuch  as  may  other- 
wife  diflurb  its  regular  action,  by  fometimes  interrupt- 
ing it,  or  fometimes  exciting  it  to  more  violent  and 
convulfive  action.®  The  latter  is  what  is  named  the 
Palpitation  of  the  Heart,  and  it  commonly  occurs  in 
the  fame  perfons  who  are  liable  to  fyncope. 
MCLXXXVIL 

It  is  this,  as  I  judge,  that  leads  us  to  perceive  in 
what  manner  thefe  organic  affections  of  the  heart  and 
great  veflels  may  occafion  fyncope :  for  it  may  be 
fuppofed,  that  the  violent  exertions  made  in  palpita- 
tions may  either  give  occafion  to  an  alternate  great 

relax- 


O  F     P  H  Y  S  I  C.  109 

relaxation,  (MCLXXVX i :.)  or  to  a  fpafrnodic  contrac- 
tion ;  and  in  either  way  fuipend  the  action  of  the 
heart,  and  occafion Tyncope.  It  fcems  to  me  probable, 
that  it  is  a  fpafmodic  contraction  of  the  heart  that  oc- 
cafions  the  intermiflion  of  the  pulfe  fo  frequently  ac- 
companying palpitation  and  fyncope. 
MCLXXXVIil. 

Though  it  frequently  happens  that  palpitation  and 
fyncope  arife,  as  we  have  faicl,  from  the  organic  affec- 
tions above  mentioned,  it  is  proper  to  cbferve,  that 
difeafes,  even  when  in  a  Violent  degree,  do  not  always 
depend  on  fuch  caufes  acting  directly  on  the  heart, 
but'  are  o;ten  depend'enc  on  fonie  of  thofe  caufes 
which  we  have  mentioned  above  as  acting  primarily 
on  the  brain. 

MCLXXXIX. 

I  have  thus  endeavoured  to  give  the  pathology  of 
fyncope  ;  and  of  the  cure  I  can  treat  very  fhortly. 

The  cafes  of  fyncope  depending  on  the  fecond  fet 
of  caufes,  (MCLXXIV.)  and  fully  recited  in  MCLXXXV. 
I  fuppofe  to  be  generally  incurable  ;  as  our  art,  fo  far 
asl  know,  has  not  yet  taught  us  to  cure  any  of  thofe 
feveral  caufes  of  fyncope  (MCLXXXV.) 

The  cafes  of  fyncope  depending  on  the  firft  fet  of 
caufes.  (MCLXXIV.)  and  whole  operation  I  have  endea- 
voured to  explain  in  MCLXXVII.  et  feq.  I  hold  to  be 
generally  curable,  either  by  avoiding  the  feveral  occa- 
iional  caufes  there  pointed  out,  or  by  correcting  the 
predifponent  caufes  (MCLXXXIV.)  The  latter,  I  think, 
may  generally  be  done  by  correcting  the  debility  or 
mobility  of  the  fyftem,  by  the  means  which  I  have  al- 
ready had  occafion  to  point  out  in  another  place*. 

CHAP. 

*  See  Aiticle  217,   &c. 


io  PRACTICE 

C     H     A     P.        II. 
OF  DYSPEPSIA,  OR  INDIGESTION. 


MCXC, 

A  WANT  of  appetite,  a  fqueamimnefs,  fometimes 
a  vomiting,  fudden  andtrarilientdiftentionsof  the 
ilomachjeruclations  of  various  kinds,  heartburns,  pains 
inthereg-ons  of  the  ftomach,  and  a  bound  belly,  are  fymp- 
toffis  which  frequently  concur  in  the  fame  perfon,  and 
therefore  may  be  prefumed  to  depend  upon  one  and 
the  fame  proximate  caufe.  In  both  views,  therefore^ 
they  may  be  coniidered  as  forming  one  and  the  fame 
difeafe,  to  which  we  have  given  the  appellation  of 
Dyfpepjia?  fct  at  the  head  of  this  chapter. 

MCXCL 

But  as  this  difeafe  is  alfo  frequently  a  fecondary  and 
fympathic  afiecxion,ib  thefyrnpioms  above-mentioned 
are  often  joined  with  many  others  ;  and  this  has  given 
occalion  to  a  very  confufed  and  undetermined  defcrip- 
tion  of  it,  under  the  general  title  of  Nervous  Difeafes, 
or  under  that  of  Chronic  Weaknefs.  It  is  proper, 
however,  to  diftinguifti ;  and  I  apprehend  the  fymp? 
toms  enumerated  above  are  thofe  effential  to  the  idio- 
pathic  affection  I  am  now  to  treat  of. 
MCXCII. 

It  is  indeed  to  be  particularly  obferved,    that  thefe 
fymptorns  are  often  truly  accompanied  with  a  certain 
ftate  of  mind  which   may  be  confidered  as  a  part  of 
the  idiopathic  affection:  but  I  lhall  take  no  further 
notice    of  this  fymptom   in  the  prefent  chapter,  as  it 
will  be  fully  and  more  properly  confidered  in  the  next, 
under  the  tide  of  Hypochondriacs. 
MCXCIII. 

That  there  is  a  difliacl  difeafe  attended  always  with 

a  greater 


OF    PHYSIC.  lit 

a  greater  part  of  the  above  fymptoms,  Is  rendered 
very  probable  by  this,  that  all  theie  feveral  fymp- 
toms may  arife  from  one  and  the  fame  caufe;  that  is7 
from  an  imbecility,  lofs  of  tone,  and  weaker  action  in 
the  mufcular  fibres  of  the  ftomach  :  and  I  conclude 
therefore,  that  this  imbecility  may  be  coniidered  as  the 
proximate  caufe  of  the  difeafe  I  am  to  treat  of  under 
the  name  of  Dyfpepfia. 

MCXCIV. 

The  imbecility  of  the  ftomach,  and  the  confequent 
fymptoms  (MCXC.)  may,  however,  frequently  depend 
upon  fome  organic  affection  of  the  ftomach  itfelf,  as 
tumour,  ulcer,  or  fcirrhofity  ;  or  upon  fome  arFeftion 
of  other  parts  of  the  body  communicated  to  the  fto-' 
mach,  as  in  gout,  amenorrhcea,  and  fome  others.  In 
all  thefe  cafes,  however,  the  dyfpeptic  fymptoms  are 
to  be  coniidered  as  fecondary  or  fympathic  affections ,. 
to  be  cured  only  by  curing  the  primary  difeafe. — 
Such  fecondary  and  fympathic  cafes  cannot,  indeed, 
be  treated  or  here;  but  as  I  prefume  that  the  imbeci- 
lity of  the  ftomach  may  often  take  place  without»ei- 
ther  any  organic  affedion  of  this  part,  or  any  more 
primary  affection  in  any  other  part  of  the  body ;  fo  I 
fuppoie  and  expecl  it  will  appear,  from  the  confedera- 
tion of  the  remote  caufes,  that  the  dyfpepfia  may  be 
often  an  idiopathic  affection,  and  that  iris  therefore 
properly  taken  into  the  fyftem  of  methodical  Ncfology, 
and  becomes  the  fubjeft  of  our  conlideration  here. 
MCXCV. 

There  can  be  little  doubt,  that  in  moft  cafes,  the 
weaker  action  of  the  mufcular  fibres  of  the  ftomach, 
is  the  moft  frequent  and  chief  eaufe  of  the  fymptoms 
mentioned  in  MCXC.  ;  but  I  dare  not  maintain  it  to  be 
the  only  caufe  of  idiopathic  dyfpepfia.  There  isr 
pretty  certainly,  a  peculiar  fluid  in  the  ftomach  of  ani- 
mals, or  at  leaft  a  peculiar  quality  in  the  fluids,  that 
we  know  to  be  there,  upon  which  th^folution  of  the 

all- 


ii2  PRACTICE 

aliments  taken  into  the  ftomach  chiefly  depends  :  and 
i;  is  at  the  Dime  time  probable,  that  the  peculiar  quali- 
ty of  the  diflblving  or  digefting  fluids  may  be  variouf- 
iy  changed,  or  that  their  quantity  may  be,  upon  occa- 
fion,  diminifhed.  It  is  therefore  ftifficiently  probable, 
that  a  change  in  the  quality  or  quantity  of  thefe  tiuids 
may  produce  a  coniiderable  difference  in  the  pheno- 
mena of  digeftipn,  and  particularly  may  give  occafion 
to  many  of  the  morbid  appearances  mentioned  in 
MCXC. 

MCXCVL 

This  feems  to  be  very  well  founded,  and  points  out 
another  proximate  caufe  of  dyfpepfia  befide  that  we 
have  already  afiigned :  But,  notwithstanding  this,  as 
the  peculiar  nature  of  the  digeftive  fluid,  the  changes 
which  it  mayv undergo,  or  thecaufes  by  which  it  may 
be  changed,  are  ail  matters  fo  little  known,  that  I  can- 
not found  any  practical  doctrine  upon  any  fuppofition 
with  refpect  to  them  ;  and  as,  at  the  fame  time,  the  im- 
becility of  the  ftomach,  either  as  caufing  the  change  in 
the  digeftive  fluid,  or  as  being  induced  by  that  change, 
feems  always  to  be  preient,  and  to  have  a  great  mare  in 
occafioning  thefymptoms  of  indigeftion;  fo  I  fhall  ftill 
coniider  the  imbecility  of  the  ftomach  as  the  proximate 
and  almofl  fole  caufe  of  dyfpepiia.  And  I  more  rea- 
dily admit  of  this  manner  of  proceeding  ;  as,  in  my 
opinion,  the  doctrine  applies  very  fully  and  clearly  to 
the  explaining  the  whole  of  the  practice  which  expe- 
rience has  eftablifhed  as  the  moft  fuccefsful  in  this 
difeafe. 

MCXCVII. 

Considering  this,  then,  as  the  proximate  caufe  of 
dyfpepfia,  I  proceed  to  mention  the  feveral  remote 
caufesof  this  difeafe  ;  as  they  are  fuch,  as,  on  differ- 
ent occafions,  feem  to  produce  a  lois  of  tone  in  the 
mufcular  fibres  of  the  ftomach.  They  may,  I  think, 
be  confidered  under  two  heads.  The  jfr/2  is,  of  thofe 

which 


O  F    P  H  T  S  I  C.  113 

•which  a&  directly  and  immediately  upon  the  flomach 
itfelf:  The  fecond  is,  of  thofe  which  act  upon  the 
whole  body,  or  particular  parts  of  it,  but  in  confe- 
quence  of  "which  the  flomach  is  chiefly  or  almofl  only 
affected. 

MGXCVIII. 
Ofthefirftkindarc, 

1.  Certain  fedative  or  narcotic   fufoftances  taken 
into  the  flomach ;    fuch  as  tea,  coflee,    tobacco,  ar- 
dent fpirits,  opium,  bitters,  aromatics,   putrids,  and 
acefcents. 

2.  The  large  and  frequent  drinking  of  warm  water, 
or  of  warm  watery  liquids. 

3.  Frequent  forfeit,  or  immoderate  repletion  of  the 
flomach. 

4.  Frequent  vomiting  whether  fpontaneoufly  arif- 
ing,  or  excited  by  art. 

5.  Very  frequent  fpitting,  or  rejection  of  faliva. 

MCXCIX.  * 

Thofe  caufes  which  act  upon  the  \vhole  body,  or 
upon  particular  parts  and  functions  of  it,  are, 

1.  An  indolent  and  fedentary  life. 

2.  Vexation  of  mind,  and  diforderly  paflions  of  anv 
kind. 

3.  Intenfe  fludy,   or  clofe  application  to  bufincfs 
too  long  continued. 

4.  Excefs  in  venery. 

5.  Frequent  intoxication  ;  which  partly  belongs  to 
this  head,  partly  to  the  former. 

6.  The  being  much  expofed  to  moid  and  cold  air 
Vvhen  without  exercife. 

MCC. 

Though  the  difeafe,  as  proceeding  from  the  laft  fet 
of  caufes,  may  be  coniidered  as  a  fymptomatic  affec- 
tion only ;  yet  as  the  affection  of  the  flomach  is  gene- 
rally the  firft,  always  the  chief,  and  often  the  only  ef- 
fect which  thefe  caufes  produce  or  difcovcr,  I  think 
the  affection  of  the  ftomach  may  be  confidered  as  the 

VOL,  II.  P  difeafe 


PRACTICE 

difeafe  to  be  attended  to  in  practice ;  and  the  more 
properly  fo,  as  in  many  cafes  the  general  debility  is 
only  to  be  cured  by  reftoring  the  tone  of  the  ftomach, 
and  by  remedies  firft  applied  ro  this  organ. 

MCCI. 

For  the  cure  of  this  difeafe,  we  form  three  feveral 
indications ;  a  prefervative,  a  palliative,  and  a  curative. 

Thejir/l  is,  to  avoid  or  remove  the  remote  caufes 
juft  now  enumerated. 

The  fccond  is,  to  remove  thofe  fyrnptoms  which 
efpecially  contribute  to  aggravate  and  continue  the 
difeafe.  And, 

The  third  is,  to  reftore  the  tone  of  the  ftomach  ; 
that  is,  to  correct  or  remove  the  proximate  caufe  of 
the  difeafe. 

MCCIL 

The  propriety  and  neceffity  of  the  firft  indication 
is  fufficiently  evident,  as  the  continued  application, 
or  frequent  repetition  of  thofe  caufes,  muft  continue 
the  difeafe  ;  may  defeat  the  ufe  of  the  remedies  ;  or, 
in  fpite  of  thefe,  may  occallon  the  recurrence  of  the 
difeafe.  It  is  commonly  the  neglecl  of  this  indication 
which  renders  this  difeafe  fo  frequently  obftinate. — 
How  the  indication  is  to  be  executed,  will  be  fuffici- 
emly  obvious  from  the  confideration  of  the  feveral 
caufes  :  but  it  is  proper  for  the  practitioner  to  attend 
to  this,  that  the  execution  is  often  exceedingly  diffi- 
cult, becaufe  it  is  not  eaiy  to  engage  men  to  break  in 
upon  eftablimed  habits,  or  to  renounce  the  purfuit  of 
pleafure ;  and  particularly,  to  perfuade  men  that  thefe 
practices  are  truly  hurtful  which  they  have  often 
practifed  with  feeming  impunity. 

MCCIII. 

The  fymptoms  of  this  difeafe  which  efpecially  con- 
tribute to  aggravate   and  continue   it,  and  therefore 
require  to  be  more  immediately  corrected  or  removed, 
are,  firft,  the  crudities  of  the  itornach  already  produc- 
ed 


OF    PHYSIC.  115 

cd  by  the  difeafe,  and  difcovered  by  a  lofs  of  appetite, 
by  a  fenfe  of  weight  and  uneaiinefs  in  the  ftomach,  and 
particularly  by  the  eructation  of  imperfectly  digefted 
matters. 

Another  fymptom  to  be  immediately  corrected,  is 
an  unufual  quantity,  or  a  higher  degree  than  ufual,  of 
acidity  prefent  in  the  ftomach,  difcovered  by  various 
diforders  in  digeftion,  and  by  other  effects  to  be  menti- 
oned afterwards. 

The  third  fymptom  aggravating  the  difeafe,  and 
otherwife  in  itfelf  urgent,  is  coitiveuefs,  and  therefore 
conftantly  requiring  to  be  relieved. 

Mcciy. 

Thejir/l  of  thefe  fymptoms  is  to  be  relieved  by  ex 
citing  vomiting  ;  and  theuie  of  this  remedy,  therefore, 
ufually  and  properly  begins  the  cure  of  this  difeafe. 
The  vomiting  may  be  excited  by  various  means,  more 
gentle  or  more  violent.  The  former  may  anfwer  the 
purpofe  of  evacuating  the  contents  of  the  ftomach  : 
but  emetics,  and  vomiting,  may  alfo  excite  the  ordi- 
nary action  of  the  ftomach  j  and  both,  by  variouily 
agitating  the  fyftern,  and  particularly  by  determining 
to  the  furface  of  the  body,  may  contribute  to  remove 
the  caufes  of  the  difeafe.  But  thefe  latter  effects  can 
only  be  obtained  by  the  ufe  of  emetics  of  the  more 
powerful  kind,  fuch  as  the  antimonial  emetics  efpeci- 
ally  are*. 

MGCV. 

The  fecond  fymptom  to  be  palliated^  is  an  excefs  of 
acidity,  either  in  quantity  or  quality,  in  the  contents 
of  the  ftomach.  In  man  there  is  a  quantity  of  acefcent 
aliments  almofl  commonly  taken  in,  and,  as  I  think, 
always  undergoes  an  acetous  fermentation  in  the  fto- 
mach y  and  it  is  therefore  that,  in  the  human  ftomach, 

P  2  and 

*  The  formulae  and  dofes  of  antimonial  emetics  have  been  deferib- 
ed  in  a  note  on  Article  185. 


n6  FRAG  T  I  C  E 

and  in  the  ilomachs  of  all  animals  ufmg  vegetable 
food,  there  is  always  found  an  acid  prefent.  The  a- 
cid,  however,  is  generally  innocent,  and  occaiions  no 
diforder,  unlefs  either  the  quantity  of  it  is  large,  or  the 
acidity  proceeds  to  a  higher  degree  than  ufual.  But, 
in  either  of  thefe  cafes,  the  acid  occafions  various  dif- 
orders,  as  flatulency,  eructation,  heartburn,  gnawing 
pains  of  the  Itomach,  irregular  appetites  and  cravings, 
loofenefs,  griping,  emaciation,  and  debility.  To  ob- 
viate or  remove  thefe  effects  aggravating  and  continu- 
ing the  dileafe,  it  is  not  only  necefTary  to  correct  the 
acid  prefent  in  the  iiomach  ;  but,  efpecially  as  this  a- 
cid  proves  a  ferment  determining  and  increafing  the 
acefcency  of  the  aliments  afterwards  taken  in,  it  is  pro- 
per alfo,  as  foon  as  poilible,  to  correct  the  difpofuion 
to  exceffive  acidity. 

MCCVI. 

The  acidity  prefent  in  the  ffeomach  may  be  correct- 
ed by  the  ufe  of  alkaline  falls,  or  abforbent  earths* ; 

or 

*  No  part  of  the  practice  of  phyfic  requires  more  caution  than 
th'e  adminiilering  alkaline  falls,  and  abforbent  earths.  The  alkaline 
falts,  by  their  Cciuitis  quality,  corrode  the  ftomach,  and  blunt  its  ac- 
tion, when  taken  in  too  large  .quantities  ;  and  efpecially  if,  from  a 
iniftaken  diaguofis,  no  acid  is  in  the  ftomach. 

Lime-water  is  certainly  preferable  to  the  alkaline  falts  ;  its  dofe 
may  vary  from  two  to  four  ounces  twice  a-cny,  according  to  the  ur- 
gency of  the  cafe. 

The  abforbent  earths,  as  chalk,  crabs  eyes,  Sfc.  if  they  do  not 
meet  with  an  acid,  are  apt  to  concrete  into  a  hard  indiiToluble  mafs, 
by  the  mucus  of  the  ftomaeh. 

Magnefia  is  doubtlefs,  in  many  cafes,  preferable  to  the  calcareous 
earth  ;  when,  ou  account  qf  its  purgative  quality,  we  cannot  conti- 
nue its  ufe.  Chalk  is  preferable  to  the  teiiaceous  powders,  tecaufe 
it  is  free  from  that  glutinous  fubftauce  with  which  teltaceous  powders 
abound,  and  which  the  more  readily  difpofes  them  to  concrete  in  the 
ftomach.  The  dofe  of  magnefia  is  from  3i.  to  ^i.  twice  or  thrice 
a-day  ;  and  its  purgative  quality  raay,  in  many  cafes,  be  prevented, 
by  adding  to  each  dofe  of  it  ten  or  fifteen  grains  of  rhubarb,  and  li.-c 
or  fix  drops  of  oil  of  ahife-fced. 


O  F    P  H  Y  S  I  C.  117 

or  by  fuch  fubftances,  containing  thefe,  as  can  be  de- 
compofed  by  the  acid  of  the  iloraach.  Of  the  alka- 
lines,  the  cauftic  is  more  effectual  than  the  mild ;  and 
this  accounts  for  the  effects  of  lime-water.  By  em- 
ploying abforbents,  we  avoid  the  excels  of  alkali, 
which  might  fometimes  take  place.  The  abforbents 
are  different,  as  they  form  a  neutral  more  or  lefs  laxa- 
tive ;  and  hence  the  difference  between  magnefia  alba 
and  other  abforbents.  It  is  to  be  obferved,  that  alka- 
lines  and  abforbents  may  be  employed  to  excefs  ;  as 
when  employed  in  large  quantity,  they  may  deprive 
the  animal  fluids  of  the  acid  neceffary  to  their  proper 
cornpolition. 

MCCVII. 

The  difpofition  to  acidity  may  be  obviated  by  a- 
voiding  acefcent  aliments,  and  uiing  animal-food  little 
capable  of  acefcency.  This,  however,  cannot  be  long 
continued  without  corrupting  the  ftate  of  our  blood  ; 
and  as  vegetable  food  cannot  be  entirely  avoided,  the 
excefs  of  their  acefcency  may  in  fome  meafure  be  a- 
voided,  by  choofmg  vegetable  food  the  leaft  difpofed 
to  a  vinous  fermentation,  fuch  as  leavened  bread  and 
\vell  fermented  liquors,  and,  inflead  of  frefli  native 
acids,  employing  vinegar. 

MCCVIII. 

The  acid  arifing  from  acefcent  matters  in  a  found 
ftate  of  the  (lomach,  does  not  proceed  to  any  high  de- 
gree, or  is  again  icon  involved  and  made  to  difappear : 

but 

The  Deco£tum  cretaceum  of  the  Edinburgh  Pharmacopoeia  is  a 
good  form  for  the  exhibition  of  chalk.  But  chalk  ir, ay  be  given 
with  rhubarb  and  oil  of  anifc- feeds,  like  magnefja.  The  Trochitci 
c  creta  is  a  convenient  form  for  giving  the  chalk,  had  the  crabs  eyes 
been  omitted.  The  following  antacid  troches  are  both  effectual  and 
pleafant : 

&.  Magnef.  alb-  vi. 

Sacch.  alb.  511*'. 

Nuc.  mofch.  3ii. 

JV1.  f.  trochifci  cu:n  mucilagtn.  gum  tragacaath.  q.  i*. 


uS  PRACTICE 

but  .this  does  not  always  happen  ;  and  a  more  copious 
acidity,  or  a  higher  degree  of  it,  may  be  produced, 
either  from  a  change  in  the  digeflive  fluids,  become 
lefs  fit  to  moderate  fermentation  an4  to  cover  acidi- 
ty, or  from  their  not  being  fupplied  in  due  quantity. 
How  the  former  may  be  occasioned,  we  do  not  well 
underfland  ;  but  we  can  readjly  perceive  that  the  lat- 
ter, perhaps  the  former  alfo,  may  proceed  from  a 
weaker  action  of  the  mufcular  fibres  of  the  flomach. 
In  certain  cafes,  fedative  paffions,  immediately  after 
they  arife,  occaflon  the  appearance  of  acidity  in  the 
flomach  which  did  not  appear  before ;  and  the  ufe  of 
flimulants  often  corrects  or  obviates  an  acidity  that 
would  otherwife  have  appeared.  Frcm  thefe  con- 
fiderations,  we  conclude,  that  the  production  and  fub- 
fiftence  of  acidity  in  the  flomach,  is  to  be  efpecial- 
ly  prevented  by  refloring  and  exciting  the  proper  ac- 
tion of  it,  by  the  feveral  means  to  be  mentioned  here- 
after. 

MCCIX. 

But  it  is  alfo  to  be  further  obferved,  that  though 
there  are  certain  powers  in  the  flomach  for  preventing 
a  too  copious  acidity,  or  a  high  degree  of  it,  they  are 
riot  however  alwajs  fuflicient  for  preventing  aceicen- 
cy,  or  for  covering  the  acidity  produced;  and  there- 
fore, as  long  as  vegetable  fubflances  remain  in  the  flo- 
mach, their  acefcency  may  go  on  and  increafe.  From 
hence  we  perceive,  that  a  fpecial  caufe  of  the  excefs 
of  acidity  may  be,  the  too  long  retention  of  the  acef- 
ccnt  matters  in  the  flomach  ;  whether  this  may  be 
from  thefe  matters  being  of  more  difficult  folution,  or 
from  the  weaknefs  of  the  ilomach  more  flowly  dif- 
charging  its  contents  into  the  duodenum,  orfromfome 
impediment  to  the  free  evacuation  of  the  flomach  by 
the  pylorus.  The  latter  of  thefe  caufes  we  are  well 
acquainted  with,  in  the  cafe  of  a  fcirrhous  pylorus, 
producing  commonly  the  higheft  degree  of  acidity. 

la 


OFPHYSIC.  119 

In  all  the  inftances  of  this  fcirrhoiity  I  have  met  with, 
I  have  found  it  incurable  :  but  the  firft  of  thefe  caufes 
is  to  be  obviated  by  avoiding  fuch  aliments  as  are  of 
difficult  folution ;  and  thefecond  is  to  be  mended  by  the 
fcveral  remedies  for  exciting  the  action  of  the  ftomach, 
to  be  mentioned  afterwards. 

MCCX. 

The  third  fympiom  commonly  accompanying  dyf- 
pepfia,  which  requires  to  be  immediately  removed,  is 
coftivenefs.  There  is  fo  much  connection  between, 
the  feveiai  portions  of  the  alimentary  canal  with  re- 
fpect  to  the  periftaltic  motion,  that,  if  accelerated  or 
retarded  in  any  one  part,  the  other  parts  of  it  are 
commonly  affected  in  the  fame  manner.  Thus,  as  the 
brilker  action  of  the  ftomach  muft  accelerate  the  acti- 
on of  the  inteftines,  fo  the  flower  action  of  the  intef- 
tines  muft  in  fome  meafure  retard  that  of  the  fto- 
mach.  It  is  therefore  of  ccnfequence  to  the  proper 
action  of  the  ftomach,  that  the  periftaitic  motion  of 
the  interlines  determining  their  contents  downwards, 
be  regularly  continued  ;  and  that  all  coftivenefs,  or 
interruption  of  that  determination,  be  avoided.  This 
may  be  done  by  the  various  means  of  exciting  the 
action  of  the  inteftines  :  but  it  is  to  be  obferved  here, 
that  as  every  confiderable  evacuation  of  the  interlines 
weakens  their  action,  and  is  ready  therefore  to  induce 
coftivenefs  when  the  evacuation  is  over  ;  fo  thofe  pur- 
gatives which  produce  alarge  evacuation,  are  unfit  for 
correcting  the  habit  of  coftivenefs.  This,  therefore, 
Ihould  be  attempted  by  medicines,  which  do  no  more 
than  folicit  the  inteftines  to  a  more  ready  difcharge  of 
their  prefent  contents,  without  either  hurrying  their 
action,  or  increasing  the  excretions  made  into  their 
cavity  :  either  of  which  effects  might  produce  a  purg- 
ing. There  are,  I  think,  certain  medicines  peculiarly 
proper  on  this  occafion,  as  they  feem  to  ftimulate  efpe- 

ciaily 


i2o  P  R  A  C  T  I  G  E 

cially  the  great  guts,  and  to  act  little  on  the  higher 
parts  of  the  inteftinal  canal*. 

MCCXI. 

We  have  thus  mentioned  the  feveral  means  of  exe- 
cuting our  fecond  indication  ;  and  I  proceed  to  the 
third)  which  is,  as  we  have  {aid,  the  proper  curative ; 
and  it  is  to  reftore  the  tone  of  the  fiomach,  the  lofs  of 
which  we  confided  as  the  proximate  caufe  of  the  dif- 
eafe,  or  at  leaft  as  the  chief  part  of  it.  The  means  of 
fatisfying  this  indication  we  refer  to  two  heads.  One 
is,  of  thofe  means  which  operate  directly  and  chiefly 
on  the  ilomach  itfelf ;  and  the  other  is,  of  thofe  means 
which,  operating  upon  the  whole  fyfteni,  have  their 
tonic  effects  thereby  communicated  to  the  flomach. 
MCCX1I, 

The  medicines,  which  operate  directly  on  the  flo- 
mach ,  are  either  ilimulants  or  tonics. 

The  ilimulants  are  faline  or  aromatic. 

The  faline  are  acids  or  neutrals. 

Acids  of  all  kinds  fee m  to  have  the  power  of  flimu- 
lating  the  ftomach,  and  therefore  often  increafe  appe- 
tite :  but  the  native  acids,  as  liable  to  fermentation, 
may  other-wife  do  harm,  and  arc  therefore  of  ambigu- 
ous ufc.  The  acids,  therefore,  chiefly  and  fuccefs ful- 
ly employed,  are  the  vitriolic§,  muriaticf,  and  the  dif- 
tilled  acid  of  vegetables,  as  it  is  found  in  tar  water, 
which  are  all  of  them  aritizymicsf. 

The 

'*  Ten  or  fifteen  grains  of  Pil.  Ruf.  anfwer  this  purpofe  fufficiently 
well.  It  is  to  be  regretted  tijat  the  Author  did  not  mention  thofe 
certain  medicines  to  which  he  alludes. 

§  The  dofe  of  the  vitriolic  acid  ought  not  to  exceed  ten  drops, 
and  it  fhould  be  well  diluted  with  water. 

•f-    The  Tin6lura  Martis  of  the  Edinburgh  College  powerfully  fti- 
mukites  the  ilomach,  and  a 61s  at  the  fame  time  as  a  tonic  ;  its  dofe 
is  from  ten  to  twenty  drops  thrice  a-day,  in  a  fufficient  quantity  of 
any  proper  liquid,  and  it  is  a  very  agreeable  medicine, 
I.  e.  refill  fermentation. 


O  V    P  H  Y  S  I  C.  121 

The  neutral  falts  anfwering  this- intention,  are  efpe- 
cially  thofe  which  have  the  muriatic  acid  in  their 
competition,  though  it  is  prefumed  that  neutrals  of 
all  kinds  have  more  or  lefs  of  the  fame  virtue*. 

MCCXIII. 

The  aromatics,  and  perhaps  fome  other  acrids,  cer- 
tainly ftimulate  the  ftomach,  as  they  obviate  the  acef- 
cenc)  a:id  flarulency  of  vegetable  food  :  but  their  fti~ 
mulus  is  naufitory;  and  if  frequently  repeated,  and 
taken  in  large  qaantiiies,  they  may  hurt  the  tone  of 
the  ftomachj- . 

MCCXIV. 

The  tonics  employed  to  ftrengthen  the  ftomach  are 
bitters,  bitteis  and  aftringents  combined,  and  chaly- 
beaces. 

Bitters  are  undoubtedly  tonic  medicines,  both  with 
refpecl  to  the  ftomach  and  the  whole  fyftem  :  but 
their  long-continued  ufe  has  been  found  to  deftroy 
the  tone  of  the  ftomach  and  of  the  \vhole  fyftem  ;  and 
wnether  this  is  from  the  mere  repetition  of  their  to- 
nic operation,  or  from  fome  narcotic  power  joined 
with  the  tonic  in  them,  I  am  uncertain. 

MCCXV. 

Bitters  and  aftringents   combined,   are,  probably, 

more  effectual  tonics  than  either  of  them  taken  {in- 

gly  ;  and  we  fuppofefuch  a  combination  to  take  place, 

in  the  Peruvian  bark  ;  which  therefore  proves  a  pow- 

VOL.  II.  Q^  .      erful 

*  The  Sal  digeftims,  i.  c.  the  muriatic  acid  faturated  with  rege- 
table  fixed  alkali,  was  thought  to  be  preferable  to  common  fait  in 
promoting  digeftion,  Hence  its  old  name  of  Sal  digeilivus.  Its 
fuperiority  over  common  fait  is  however  doubtful, 

f  This  caution  agaiutt  the  too  free  ufc  of  aromatics  ought  to  be 
peculiarly  attended  to  by  the  young  practitioner.  The  fpeedy  re* 
lief  which  they  procure  tempts  the  patient  to  have  frequent  recourfe 
to  them,  which,  as  the  Author  juftly  obferves,  may  materially  hurt 
the  tone  of  the  ftomach,  and  confequently  increafe  the  difeafe  whick 
they  were  intended  to  remove. 


122  PRACTICE 

erful  tonic,  both  with  refpccl  to  the  flomach  and  to 
the  whole  fyitern.  But  I  have  fome  ground  to  fuf- 
pe&,  that  the  long-continued  ufe  of  this  bark  may, 
like  bitters,  deftroy  both  the  tone  of  the  flomach  and 
of  the  whole  fy  ft t  m * . 

MCCXVI. 

Chalybcates  may  be  employed  as  tonics  in  various 
forms-]*,  and  in  considerable  quantities,  with  fafety. 
They  have  been  often  employed  in  the  form  of  mine- 
ral waters,  and  feemingly  with  iuccefs :  but  whether 
this  is  owing  to  the  chalybeate  in  the  compofvtion 
of  thefe  waters,  or  to  forne  other  circumftances  at- 
tending their  ufe,  I  dare  not  politively  determine  j 
but  the  latter  opinion  feems  to  rne  the  more  probable. 

MCCXV1I. 

The  remedies  which  ilrengthcn  the  ftomach,  by  be- 
ing applied  to  the  whole  body,  are,  exercife  and  the 
application  of  cold. 

As  exercife  ftrengthens  the  whole  body,  it  muft  al- 
fo  ftrengthen  the  ftomach ;  but  it  does  this  alfo  in  a 
particular  manner,  by  promoting  perfpiration,  and 
exciting  the  aftion  of  the  veffels  on  the  furface  of  the 
body,  which  have  a  particular  confent  with  the  muf- 
cular  fibres  of  the  ftomach.  This  particularly  ex- 
plains why  the  exercifes  of  geilation,  though  not  the 
mod  powerful  in  ilrcngihening  the  whole  JTyftem,  are, 
however,  very  powerful  in  flrengtheningthe  ftcmach; 
of  which  we  have  a*  remarkable  proof  in  the  effects  of 

failing. 

*  Forms  of  thcfe  tonics  may  be  feen  in  the  preceding  notes  on 
Articles  982,  983,  993. 

f   See  the  notes  on  Articles  982,  983,  993. 

In  tlieie  cafes 'the  Tindura  Martis,  mentioned  in  the  note  on  Ar- 
ticle 1 2 1 2,  is  as  proper  a  form  of  chalybeates  as  any  we  can  ufe.  Its 
dofc  is  from  ten  to  twenty  drops  in  any  proper  vehicle.  A  glafs  of 
coldfprin--waicr.  acidulated  with  a  few  drops  of  this  tincture,  is 
agreeable  and  refrefhing,  and  may  be  tifed  as  the  patient's  commoa 
drink  ;  its  agreeablenefs  may  be  confiderably  increafed  by  adding  to 
each  half-pint  glafs,  a  tablc-fpoonful  of  fimple  cinnamon-water. 


OF    PHYSIC. 


123 


failing.  In  {lengthening  the  general  fyfteni,  as  fa- 
tigue muft  be  avoided,  fo  bodily  exercife  is  of  ambi- 
guous ufe;  and  perhaps  it  is  thereby,  that  riding  on 
horfeback  has  been  fo  often  found  to  be  one  of  the 
moft  powerful  means  of  ftrengtfeening  the  ftomach, 
and  thereby  of  curing  dyfpepiia. 
MCCXVIII. 

The  other  general  remedy  of  dyfpcplia  is  the  appli- 
cation of  cold  :  which  may  be  in  two  ways  ;  that  is, 
either  by  the  application  of  cold  air,  or  or  cold  water. 
It  is  probable,  that,  in  the  atmofphere  constantly  fur- 
rounding  our  bodies,  a  certain  degree  of  cold,  confiuer- 
ably  lefs  than  the  temperature  of  our  bodies  them- 
feives,  is  neceiTary  to  the  health  of  the  human  body. 
Such  a  degree  of  cold  Teems  to  ftrengthen  the  vefFcis 
on  the  fnrface  of  the  body,  and  therefore  the  mufcular 
fibres  cf  the  ftomach.  But,  further,  it  is  well  known, 
that  if  the  body  is  in  exercife  fufficient  to  fupport 
fuch  a  determination  to  the  furface,  as  to  prevent  the 
cold  from  producing  an  entire  conilridlion  of  the 
pores;  a  certain  degree  of  cold  in  the  atmofphere, 
with  fuch  exc^ciie,  will  render  the  perfpiration  more 
considerable.  From  the  iharp  appetite  that  in  fuch 
circumftances  is  commonly  produced,  we  can  have 
no  doubt,  that,  by  the  application  of  fuch  cold,  the 
tone  of  the  ftomach  is  confiderably  ftrengthened. 
Cold  air,  therefore,  applied  with  exercife,  is  a  moil 
powerful  tonic  with  rcfpect  to  the  ftomach  :  and  this 
explains  why,  for  that  purpofe,  no  exercifes  within 
doors,  or  in  clofe  carriages,  are  fo  ufeful  as  thofe  in 
the  open  air. 

MCCXIX. 

From  the  fame  reafoning,  we  can  perceive,  that  the 
application  of  cold  water,  or  cold  bathing,  while  it  is 
a  tonic  with  refpecl  to  the  fyftem  in  general,  and  e~ 
fpecially  as  exciting  the  action  of  the  extreme  veflels, 

2  inuft 


124  PRACTICE 

mail  iii  both  rcfpeds  be  a  powerful  means  of  ftrength- 
cning  the  tone  of  the  ftomach. 
MCCXX. 

Thefe  are  the  remedies  to  be  employed  towards  a 
radical  cure  of  idiopathic  dyfpepfia  ;  and  it  might  be, 
perhaps,  expected  here,  that  1  mould  treat  alibof  the 
various  cafts  of  the  fympathic  difeafe.  But  it  will  be 
obvious  that  this  cannot  be  properly  don-  without 
treating  of  all  the  difeafes  of  which  the  dyfpepfia  is  a 
fymptorn,  which  cannot  be  proper  in  this  place.  It 
has  been  partly  done  already,  and  will  be  further 
treated  of  in  the  courfe  of  this  work.  In  the  mean 
time,  it  may  be  proper  to  obferve,  that  there  is  not 
Co  much  occaiion  for  diftinguiming  between  the  idi- 
opathic and  fympathic  dyfpepfia,  as  there  is  in  many 
other  cafes  of  idiopathic  and  fympathic  difeafes.  For, 
as  the  fympathic  cafes  of  dyfpepfia  are  owing  to  alofs 
of  tone  in  fome  other  part  of  the  fyftem,  which  .is 
from  thence  communicated  to  the  ftomach  ;  fo  the 
tone  of  the  ftomach  restored,  may  be  communicated 
to  the  part  primarily  affe&ed  ;  and  therefore  the  reme- 
dies of  the  idiopathic  may  be  often  ufefully  employ- 
ed, and  are  often  the  remedies  chiefly  employed,  in, 
fympathic  dyfpepfia. 

MCCXXI. 

Another  part  of  our  buiinefs  here  might  be  to  fay, 
how  forne  other  of  the  urgent  fymptoms,  befides 
thofe  above-mentioned,  are  to  be  palliated.  On  this 
fubjecl:,  1  think  it  is  enough  to  fay,  that  thefymptoms 
chieily  requiring  to  be  immediately  relieved,  are  flatu- 
lency, heartburn,  other  kinds  of  pain  in  the  region  of 
the  ftomach,  and  vomiting; 

The  dyfpeptic  are  ready  to  fuppofe  that  the  whole 
of  their  difeafe  coniifts  in  a  flatulency.  In  this  it 
will  be  obvious  that  they  are  miftaken  ;  but,  although 
the  flatulency  is  not  to  be  entirely  cured,  but  by 
mending  the  imbecility  of  the  ilomach  by  the  means 

above- 


O  F    P  H  Y  S  I  C,  125 

above-mentioned  ;  yet  the  flatulent  didention  of  the 
ilomach  may  be  relieved  by  carminkives,  as  they  are 
called,  or  medicines  rhat  produce  a  difcharge  of  wind 
from  the  flomach  ;  fuch  are  the  various  aritifpafmo- 
dics,  of  which  the  mod  effectual  is  the  vitriolic  aether. 

The  heartburn  may  be  relieved  by  abforbents*,  an- 
tifpafraodics§,or  demulcentsf. 

The  other  pains  of  the  ilomach  may  be  fometimes 
relieved  by  carminitives||,  but  moil  certainly  by  opi- 
ates 

Vomiting  is  to  be  cured  tnofl;  effectually  by  opiates 
thrown  by  injection  into  the  anus. 


CHAP. 


*  The  abforbeots  have  been  defcribed  above,  fee  note  on  Article 
1296. 

§  It  may  be  doubtful  whether  antifpafmodics  are  effectual  in  re- 
moving heartburn.  Opium  undoubtedly  often  gives  relief  in  dofes 
of  twenty  or  thirty  drops  of  laudanum. 

-j-  Extract  of  liquorice  is  as  good  a  demulcent  in  thefe  cafes  as  any 
in  the  lilt  of  the  Materia  Medica.  Sucking  a  little  piece  of  it,  and 
drinking  a  cup  or  two  of  weak  lintfeed-tea  after  it,  feldom  fail  of 
giving  relief, 

jj  Carminatives  Cui table  in  thefe  cafes  are  the  eflential  oils  of  the 
feeds  of  fome  aromatic  umbiliferous  plants,  as  Ol.  Anifi.  the  dofe 
of  which  is  fifteen  or  twenty  drops  on  a  piece  of  fngar,  though  com- 
mon praftice  feldom  goes  half  that  length.  The  Oleum  I  arvi  is 
another  excellent  carminative,  but  it  is  very  hot,  and  its  dofe  muifc 
never  exceed  five  drops  ;  two  drops  are  a  moderate  dofe.  'The  O- 
Jcum  Menthae  is  another  good  carminative  ;  its  dofe  is  two  or  three 
drops  on  a  piece  of  fugar. 

Two  grains  of  the  Extract  of  opium,  or  forty  drops  of  the  lauda- 
num, are  ufually  given  in  half  a  cupful  of  lintfeed  tea.  The  dote 
may  be  incrcafed  to  100  drops  of  laudanum,  in  the  fame  quantity  of 
vehicle,  efpecially  if  the  pain  of  the  Ilomach  be  accompanied  with 
fomi  tings. 


126  PRACTICE 

C    II     A    P.       III. 
OF    HYPOCHONDRIASIS, 

OR    THE 

HYPOCHONDRIAC     AFFECTION, 

COMMONLY    CALLED 

VAPOURS  OR  LOW  SPIRITS. 

MCCXXIL 

IN  certain  perfons  there  is  a  ftate  of  mind  diftin- 
guiihed  by  a  concurrence  of  the  following  cir- 
cumiiances  :  A  langour,  liftlelTnefs,  or  want  of  refolu- 
tion  and  activity  with  refpecl  to  all  undertakings ;  a 
difpoiitlon  to  ferioufnefs,  fadncfs,  and  timidity ;  as  to 
all  future  events,  an  appreheniion  of  the  worft  or  moft 
unhappy  ftate  of  them  ;  and  therefore,  often  upon 
flight  grounds,  an  appreheniion  of  great  evil.  Such 
perfons  are  particularly  attentive  to  the  ftate  of  their 
own  health,  to  even  the  fmalleft  change  of  feeling  in 
their  bodies;  and  from  any  unufual  feeling,  perhaps 
of  the  High  ted  kind,  they  apprehend  great  danger, 
and  even  death  itfclf.  In  refpecl:  to  all  thefe  feelings 
and  appreheniions,  there  is  commonly  the  molt  obfti-' 
nate  belief  and  perfuafion. 

MCCXXIII. 

This  ftate  of  mind  is  the  Hypochondriafis  of  medi- 
cal writers.  See  Linmsi  Genera  Morborum,  Gen. 
76.  et  Sagari  Syfiema  Symptomaticum,  Clafs  XIII. 
Gen.  5.  The  fame  ftate  of  mind  is  what  has  been 
commonly  called  Vapours  and  Low  Spirits.  Though 
the  term  Vapours  may  be  founded  on  a  falfe  theory, 
and  therefore  improper,  I  beg  leave,  for  a  purpofe 

that 


OF    PHYSIC.  127 

tbat  will  immediately  appear,  to  employ  it  for  a  little 

here, 

MCCXXIV. 

Vapours,  then,  or  the  Hate  of  mind  defcribed  above, 
is,  Lke  every  other  ftate  of  mind,  conne&ed  with  a 
a  certain  ftate  of  the  body,  which  muft  be  inquired  in- 
to in  order  to  its  being  treated  as  a  difeafe  by  the  art 
of  phyfic. 


This  ftate  of  the  body,  however,  is  not  very  eafily 
afcertained  :  for  we  can  perceive,  that  on  different  oc- 
cafions  it  is  very  different;  vapours  being  combined 
fometirnes  with  dyfpepfia,  fometimes  with  byiteria,  and 
fometimes  with  melancholia,  which  are  difeafes  feem- 
ingly  depending  on  very  different  ftates  of  the  body. 
MCCXXVI. 

The  combination  of  vapours  with  dyfpepfia  is  very 
frequent,  and  in  feemingly  very  different  circuroftan- 
ces.  it  is,  efpeeiaily,  thefe  different  circumftances 
that  I  would  wifli  to  afcertain  ;  and  I  remark,  that  they 
are  manifeftly  of  two  different  kinds.  Firft,  as  the 
difeafe  occurs  in  young  perfons  of  both  fexes,  in  per- 
fons  of  a  fanguine  temperament,  and  of  a  lax  and  flac- 
cid habit.  Secondly,  as  it  occurs  in  elderly  perfons  of 
both  fexes,  of  a  melancholic  temperament,  and  of  a 
firm  and  rigid  habit. 

MCCXXVII. 

Thefe  two  different  cafes  of  the  combination  of  the 
vapours  and  dyfpepfia,  I  confider  as  two  diftincl:  dif- 
eafes, to  be  diftinguifhed  chiefly  by  the  temperament 
prevailing  in  the  perfons  affected. 

As  the  dyfpepfia  of  fanguine  temperaments  is  often 
without  vapours;  and  as  the  vapours  when  joined 
with  dyfpepfia  in  fuch  temperaments,  may  be  conii- 
dered  as,  perhaps,  always  a  fymptom  of  the  affeclion 
of  the  ftomach  ;  fo  to  this  combination  of  dyfpepfia 
and  vapours,  I  would  ftill  apply  the  appellation  of 


128  PRACTICE 


confider  it  as  flricHy  the  difcafe  treated 
of  jn  the  preceding  chapter, 

But  the  combination  of  dyfpepfia  and  vapours  in 
melancholic  temperaments,  as  the  vapours  or  the 
turn  of  mind  peculiar  to  the  temperament,  nearly  that 
defcribed  above  in  MCCXXII.  are  efTential  circumilan- 
ces  of  the  difcafe  ;  and  as  this  turn  of  mind  is  often 
with  few,  or  only  flight  fymproms  of  dyfpepfia  ;  and, 
even  though  the  latter*  be  attending,  as  they  feem  to 
be  rather  the  effects  of  the  general  temperament,  than 
of  any  primary  or  topical  affection  of  the  ilomach  ;  I 
confider  this  combination  as  a  very  different  difeafe 
from  the  former,  and  would  apply  to  it  ftridly  the  ap- 
pellation of  Hypochondria  fis. 

MCCXXVIII. 

Having  thus  pointed  out  a  diftincHon  between  Dyf- 
pepfia and  Hypochondriacs,  I  fhall  now,  ufing  thefe 
terms  in  the  flricl  fenfe  above  mentioned,  make  fome 
cbfervations  which  may,  I  think,  illuftrate  the  fubjecl, 
and  more  clearly  and  fully  eflablifh  the  diflindtion 
propofed. 

MCCXXIX. 

The  dyfpepfia  often  appears  early  in  life,  and  is 
frequently  much  mended  as  life  advances  :  but  the 
hypochondriacs  feldom  appears  early  in  life,  and  more 
ufually  in  more  advanced  years  only  ;  and  more  cer- 
tainly ftill,  when  it.  has  once  taken  place,  it  goes  on 
increafmg  as  life  advances  to  old  age. 

This  feems  to  be  particularly  well  ill  unrated,  by 
our  obferving  the  changes  in  the  flate  of  the  mind 
which  ufually  take  place  in  the  courfe  of  life.  In 
youth,  the  mind  is  chearful,  aclive,  rafh,  and  movea- 
ble  :  but  as  life  advances,  the  mind  by  degrees  be- 
comes more  ferious,  flow,  cautious,  and  fteady  ;  till  at 
length,  in  old  age,  the  gloomy,  timid,  diftruiiful,  and 
obitinate  Mate  of  melancholic  temperaments,  is  more 
exquifitely  formed.  In  producing  thefc  changes,  it  is 

true, 


OF    PHYSIC.  129 

true,  that  moral  caufes  have  a  flrire  ;  but  it  is  at  the 
lame  time  obvuus,  that  the  temperament  of  the  body 
determines  the  operation  of  thefe  moral  caufes,  fooner 
or  later,  and  in  a^reater  or  leffer  degree,  to  have  their 
effects.  The  fanguine  temperament  retains  longer  the 
character  of  youth,  while  the  melancholic  tempera- 
ment brings  on  more  early  the  manners  of  old  age. 

MCCXXX, 

Upon  the  whole,  it  appears,  that  the  (late  of  the 
mind  which  attends,  and  efpecially  diitinguifhes  hy- 
pochoqdriafis,  .is  the  effect  of  that  fame  rigidity  of  the 
folios,  torpor  of  the  nervous  power,  and  peculiar  ba- 
lance between  the  arterial  and  venous  fyftems  which 
occur  in  advanced  life,  and  which  at  all  times  take 
place  more  or  lefs  in  melancholic  temperaments.  If 
therefore  there  bealfo  fomewhatof  a  like  flats  of  mind 
attending  the  dyfpepfia  which  occurs  early  in  life  in 
fanguine  temperaments  and  lax  habits,  it  mult  depend 
upon  a  different  Itate  of  the  body,  and  probably.up- 
on  a  weak  and  moveable  ftate  of  the  nervous  power. 

MCCXXXJ. 

Agreeable  to  all  this,  in  dyfpepfia,  there  is  more  of 
fpaimodic  affection,  and  the  affection  of  the  mind  (M- 
ccxxn.)  is  often  abfent,  and,  when  prefent,  is  perhaps 
always  of  a  ilighter  kind  :  while,  in  hypochondriacs, 
the  affection  of  the  mind  is  more  conitant,  and  the 
fymptorns  of  dyfpepfia,  or  the  affections  of  the  fto- 
mach,  are  often  abfent,  or,  when  prefent,  are  in  a 
/lighter  degree.  , 

I  believe  the  affection  of  the  mind  is  commonly  dif- 
ferent in  the  two  difeafes.  In  dyfpepfia,  it  is  often 
languor  and  timidity  only,  eafily  difpelled  ;  while  in 
hypochondriacs,  it  is  generally  the  gloomy  and  ri- 
vetted  apprehenfion  of  evil. 

The   two  difeafes  are  alfo  diftingui/hed  by  fomc  o- 
ther  circumftances.     Dyfpepfia,  as  I  have  fuid,  is  off- 
en  a  fymptomatic  affection  ;   while  hypochondriacs 
VOL.  II.  R  is, 


r  jd  PRACTICE 

is,  perhaps,  always  a  primary  and  idiopathie  difeafe. 
As  debility  may  be  induced  by  many  different  cauf- 
cs,  dyfpepfia  is  a  frequent  difeafc  ;  while  hvpochondri- 
afisD  depending  upon  a  peculiar  temperament,  is  more 
rare. 

MGCXXXII. . 

Having  thus  endeavoured  to  diftinguifli  the  two  di£ 
eafes,  I  iuppofb  the  peculiar  nature  and  proximate 
caufe  of  Hypochondria/is  will  be  understood ;  and  I 
proceed  therefore  to  treat  of  its  cure. 

So  far  as  the  affections  of  the  body,  and  particular- 
ly of  the  flomach,  are  the  fame  here  as  in  the  cafe  of 
dyfpefifia,  the  method  of  cure  might  be  fuppofeti  to  be 
allb  the  fame ;  and  accordingly  the  practice  has.  been 
carried  on  with  little  diitinction  :  but  I  am  perfuaded 
that  a  diflinclion  is  often 'necefiary. 
MCCXXX11I. 

There  may  be  a  foundation  here  for  the  fame  pre- 
'fervativc  indication  as   firft  laid  down  in  the  cure  of 
dyfpepfia-y  (MCCII.)  but    I  cannot  treat  this  fubjeft  fo 
clearly  or  fully   as  I  could  wiili,    becaufe  I  have  noc 
yet  had  fo  much  opportunity  of  obfervation  as  I  think 
necefiary  to  ascertain  the  remote  caufes  ;  and   1   can 
hardly  make  life  of  the  observations   of  others,   who 
have  feldom  or  never  diftinguiihed  between  the  two 
difeafes.     What,  indeed,  has  been  fald  with  rcfpecl  to 
the  remote  caufes  of  melancholia,  will  often  apply    to 
the    hypochondriacs,  which  I  now  treat  of;   but  the 
fubject  of  the  former  has  been  fo  much  involved  in  a 
doubtful  theory,  that  I  find  it  difficult  to  feleft  the 
facts  that  might  properly   and  ilricliy  apply  to   the 
latter.     I  delay  this  fubjed;,  therefore,  till  another  oc- 
cafion  ;  but  in  the  mean  time  trull,   that  what  I  have 
fatd  regarding  the  nature  of  the  difeafe,  and  fome  re- 
marks I  fhall  have  occaiion  to  offer  in  confidering  the 
method  of  cure,   may  in  foms  meafure  fupply  my  defi- 
ciency on  this  fubjed  of  the  remote  caufes. 

MCCXXXIV. 


O  F    P  H  Y  S  I  C,  131 

MCCXXXIV. 

The  fecond  indication  laid  down  in  the  cure  of  dyf- 
•jpepfia  (MCCI.)  has  properly  a  place  here:   but  it  is  itill 
to  be  executed  with  fome  diitinction. 
MCCXXXV. 

An  anorexia,  and  accumulation  of  crudities  in  the 
.ftomach,  does  not  fo  commonly  occur  in  hypochon- 
driafis  as  in  dyfpepiia ;  and  therefore  vomiting  (M- 
cciv.)  is  not  io  often  necetfary  in  the  former  as  in 
the 'latter. 

MCGXXXVI. 

The  tymptcm  of  excefs  of  acidity,  from  the  flow 
evacuation  of  the  ftomach  in  melancholic  tempera- 
ments, often  arifes  to  a  very  hi6h  degree  in  hypochon- 
drialis  ;  and  therefore,  for  the  fame  reafon  as  in  MCCV. 
it  is  to  be  obviated  and  corrected  with  the  utmoft 
care.  It  is  upon  this  account  that  the  feveral  anta- 
cids, and  the  other  m,eans  of  obviating  acidity,  are  to 
be  employed  in  hypochondriails,  and  with  the  fame 
attentions  and  confederations  as  in  MCCVI.  and  follow- 
ing ;  with  this  reflection,  however,  that  the  exciting 
the  action  of  the  ilomach  there  mentioned,  is  to  be 
a  little  differently  undcrftood,  as  {hall  be  hereafter 
explained. 

MGGXXXVII. 

As  coflivenefs,  and  that  commonly  to  a  confiderable 
degree,  is  a  very  conftant  attendant  of  hypochondria- 
fis,  fo  it  is  equally  hurtful  as  in  dyfpepfia.  It  may  be 
remedied  by  the  fame  means  in  the  former  as  in  the 
latter,  and  they  -are  to  be  employed  with  the  fame  rer 
Unctions  as  in  MCCX. 

MCCXXXVIIF. 

It  is  efpecially  with  refpect  to  the  third  indication 
Jaid  down  in  the  cure  of  dyfpepfia  (MCCI.)  that  there 
is  a  difference  of  practice  to  be  obferved  in  the  cure 
of  hypochondriacs ;  and  that  often  one  directly  op- 

R  2 


132  PRACTICE 

pofite  to   that  in  the  cafe  of  dyfpepHa,  is  to  be  fol- 
lowed. 

MCXXX1X. 

In  dyfpepfia,  the  chief  remedies  are  the  tonic  medi-  • 
cines,  which  to  me  feem  neither  neceffary  nor  fafe  in 
hypochondriacs ;  for   in    this   there  is  not  a  lofs    of 
tone,  but  a  want  of  activity  that  is  to  be  remedied. 

Chalybeate  mineral  waters  have  commonly  been 
employed  in  hypochondriacs,  and  feemingly  withfuc- 
cefs.  But  this  is  probably  to  be  imputed  to  the  arnufe- 
ment  and  exercife  ufually  accompanying  the  ufe  of 
thefe  waters,  rather  than  to  the  tonic  power  of  the 
frnall  quantity  of  iron  which  they  contain.  Perhaps 
the  elementary  water,  by  favouring  the  excretions^ . 
mav  have  a  mare  in  relieving  the  difeafe. 

MCCXL. 

Cold  bathing  is  often  highly  ufeful  to  the  dyfpeptic, 
and,  as  a  general  fiimulant,  may  fometimes  feern  ufeful 
to  the  hypochondriac;  but  it  is  not  commonly  fo  to 
the  latter  ;  while,  on  the  other  hand,  warm  bathing, 
hurtful  to  the  dyfpeptic,  is  often  extremely  ufeful  to 
the  hypochondriac. 

MCCXLI. 

Another  inftance  of  a  contrary  practice  neceffary  in  ; 
the  two  difeafes,   and  illuflrating  their  refpective  na-| 
tures,  is,    that   the  drinking  tea  and  coffee  is  always 
hurtful  to  the  dyfpeptic,   but  is  commonly  extremely 
ufeful  to  the  hypochondriac. 

MCCXLII. 

Exercife,  as  it  ftrengthens  the  fyftcm,  and  thereby,, 
the  ftomach,  and  more  efpecially,  as  by  increafing  the 
perfpiration,   it  excites  the  action  of  the  ftomach,  it$ 
proves  one  of  the  mod  ufeful  remedies  in  dyfpepfia  ; 
and  further,   as,  by  increafing  the  perfpiration,  it  ex-- 
cites the  activity  of  the  ftomach,  it  likewife  proves  air 
ufeful  remedy  in  the  hypochondriaiis,.       However,  itf 
the  latter  cafe,  as  I  fhail  explain  prefently,  it  is  ftill  a' 

more 


O  F      PHYSIC.  133 

more  ufeful  remedy  by  its  operation  upon  the  mind 
than  by  that  upon  the  bodv. 

MCCXLIII. 

It  is  now  proper  that  we  proceed  to  confider  the 
mod  important  article  of  our  practice  in  this  difeafe, 
and  which  is,  to  confider  the  treatment  of  the  mind  ; 
an  affection  of  which  fornetimes  attends  dyfpepfia,  but 
is  always  the  chief  circumftance  in  hypochondriacs. 
What  1  am  to  tugged  here,  will  apply. to  both  difeafes ; 
but  it  is  the  hypochondriacs  that  I  am  to  keep  moil 
conftantly  in  view. 

MCCXLIV. 

The  management  of  the  mind  in  hypochondriacs, 
is  often  nice  and  difficult.  The  firm  pe  fuaiion  that 
generally  prevails  in  fuch  patients,  does  not  allow  their 
feelings  to  be  treated  as  imaginary,  nor  their  appre- 
henfion  of  danger  to  be  confidered  as  groundlels, 
though  the  phyfician  may  be  perfuaded  that  it  is  the 
cafe  in  both  relpecls.  Such  patients,  therefore,  are 
not  to  be  treated  either  by  raillery  or  by  reafoning. 

It  is  fa  id  to  be  the  manner  of  hypochondriacs  to 
change  often  their  phyfician  ;  and  indeed  they  often 
do  it  confidently ;  for  a  phyfician  who  does  not  admit 
the  reality  of  the  difeafe,  cannot  be  fuppofed  to  take 
much  pains  to  cure  it,  or  to  avert  the  danger  of  which 
he  entertains  no  appreheniion. 

If  in  any  cafe  the  pious  fraud  of  a  placebo  be  al- 
lowable, it  feems  to  be  in  treating  hypochondriacs  : 
who,  anxious  for  relief,  are  fond  of  medicines,  and, 
though  often  difappointed.  will  dill  tade  every  new 
drug  that  can  be  propofed  to  them. 
MCCXLV. 

As  it  is  the  nature  of  man  to  indulge  every  prefent 
motion,  fo  the  hypochondriac  cherifhes  his  fears,  and, 
attentive  to  every  feeling,  finds  in  trifles  light  as  air  a 
ftrong  confirmation'  of  his  appreheniions.  His  cure 
therefore  depends  especially  upon  the  interruption  of 

his 


134  PRACTICE 

his  attention,  or  upon  its  being  diverted  to  other  ob* 
jeds  than  his  own  feelings. 

MCCXLVI. 

Whatever  averficn  tc  application  of  any  kind  may 
appear  in  hypochondriacs,  there  is  nothing  more  per* 
nicious  to  them  than  abfclute  idlenefs,  or  a  vacancy 
from  all  earneft  purfuit.  It  is  owing  to  wealth  admit- 
ting of  indolence,  and  leading  to  the  purfuit  of  tranfi- 
tory  and  unfatisfying  amufements,  or  to  that  of  ex- 
hauiling  pleasures  only,  that  the  prefent  times  exhibit 
to  us  fo  many  inflances  of  hypochondriacifm. 

The  occupations  of  buiinefs  fukable  to  their  cir- 
cumftances  and  fituation  in  life,  if  neither  attended 
with  emotion,  anxiety,  nor  fatigue,  are  always  to  be 
admitted,  and  p.rliited  in  by  hyponchondmcs.  But 
occupations  upon  which  a  man's  fortune  depends,  and 
•whicii  are  always j  therefore,  objects  of  anxiety  to  me- 
lancholic men  ;  and  more  particularly  where  fuch  oc- 
cupations are  expofed  to  accidental  interruptions,  dif- 
vippointments,  and  failures,  it  is  from  theie  that  the 
hypochondriac  is  certainly  to  be  withdrawn. 
MCCXLVII.' 

The  hypochondriac,  who  is  not  necefTarily,  by  cir-* 
cumftances  or  habits,  engaged  in  buiinefs,  is  to  be 
drawn  from  his  auction  to  his  own  feelings  by  fofne 
amufement. 

The  various  kinds  of  fport  and  hunting,  as  purfued 
with  forne  ardour,  and  attended  with  exerciie,  if  not 
too  violent,  are  amongft  the  mod  ufeful. 

All  thole  amufements  which  are  in  the  open  air, 
joined  with  moderate  exercife,  and  requiring  fome 
dexterity,  are  generally  of  ufe. 

Within  doors,  company  which  engages  attention, 
which  is  willingly  yielded  to,  and  is  at  the  fame  time 
of  a  chearfui  kind,  will  be  always  found  of  great 
fervice. 

Play,  in  which  fome  fkill  is  required,  and  where 

the 


OF    PHYSIC.  135 

the  flake  is  not  an  object  of  much  anxiet  J5  if  not  too 
long  pro  traded,  may  often  be  admitted. 

In  dyfpeptics,  however,  gaming,  liable  to  fuddcn 
and  coimderable  emotions,  is  dangerous,  and  the  long 
continuance  of  it,  with  night-watching,  is  violently 
debilitating.  But  in  melancholies,  who  commonly 
excel  in  (kill,  and  are  leis  fufceptible  of  violent  emo- 
tions, it  is  more  admiflible,  and  is  often  the  only  a- 
mufemerit  that  can  engage  them. 

Mufic,  to  a  nice  ear,  is  a  hazardous  amufement,  as 
long  attention  to  it  is  very  fatiguing. 
MCCXLVIII. 

It  frequently  happens,  that  amufements  of  every 
kind  are  rejected  by  hypochondriacs  ;  and  in  that  cafe, 
mechanical  means  of  interrupting  thought  are  the  re- 
medies to  be  fought  for. 

Such  is  to  be  found  in  brife  exercife,  which  requires 
fome  attention  in  the  conduct  of  it. 

Walking  is  leldom  of  this  kind;  though,  as  grati- 
fying to  the  reftleifnefs  of  hypochondriacs,  it  hasfome- 
times  been  found  ufeful. 

The  required  interruption  of  thought  is  beft  obtain- 
ed by  riding  on  horfeback,  or  in  driving  a  carnage  of 
any  kind. 

The  exercife  of  failing,  except  it  be  in  an  open 
boat,  engaging  fome  attention,  does  very  little  djer- 
vice. 

Exercife  in  an  eafy  carriage,  in  the  direction    of 
which  the  traveller  takes  no   part,  unlefs    it   be  upon 
rough  roads,  or  driven  pfetty  quickly,  and  with  long 
continuance,  is  of  little  advantage. 
MCCXLIX. 

Whatever  exercife  may  be  employed,  ic  will  be 
moft  effectual  when  employed  in  the  purfuit  of  a  jour- 
ney ;  firft,  becaufe  it  withdraws  a  perfon  from  many 
objects  of  unealinefs  and  care  which  might  prefent 
themfelves  at  home  ;  fecondly,  as  it  engages  in  more 

con- 


136  PRACTICE 

conftantexercife,  and  in  a  greater  degree  of  it  than  is 
commonly  taken  in  airings  about  home;  and,  laflly, 
as  it  is  conftantly  prefenting  new  objects  which  c;ill 
forth  a  perfon's  attention. 

MCCL. 

In  our  fyftem  of  Nofology  we  have,  next  to  Hypo- 
chondriaiis,  placed  the  Chlorofis,  bccaufe  I  once 
thought  it  might  be  confidered  as  a  genus  comprehend- 
ing, beiides  the  Chlorolis  of  Amenorrhcea,  fome  fpe- 
cies  of  Cachexy  :  but,  as  I  cannot  find  this  to  be  well 
founded,  and  cannot  diftinctly  point  out  any  fuch  dif- 
eafe,  I  now  omit  confidenng  Chlorofis  as  a  genus 
here;  and,  as  a  fymptom  of  Amenorrhcea,  I  have 
endeavoured  before  to  explain  it  under  that  title. 


BOOK         III. 

O    F 

SPASMODIC     AFFECTIONS, 
WITHOUT  FEVER. 

MCCLI. 

UNDER   this   title  1   am  to  comprehend  all  the 
difeafes  which  confift  in  motu  abnormi ;  that  is, 
in   a  preternatural  ftate  of  the  contraction  and  motion - 
of  the  mufcular  or  moving  fibres  in  any  part  of  the 
body. 

MCCLII. 

It  will  hence  appear,  why,  under  this  title,  I  have 
comprehended  many  more  difeafes  than  Sauvages  and 
Sagar  have  comprehended  under  the  title  of  fpafmi, 
or  that  Linnaeus  has  done  under  the  title  of  Motorii. 

But 


O  F     P  H  Y  S  I  C.  137 

But  I  expect  it  will  be  obvious,  that,  upon  this  occa- 
iion,  it  would  not  be  proper  to  confine  our  view  to 
the  affections  of  the  voluntary  motion  only ;  and  if 
thofe  Nofologifts  have  introduced  into  the  clafs  of 
Spafmi,  Palpitatio  and  Hvfteria,  it  will  be  with  equal 
propriety  that  Afthma,Coiica,  and  many  other  difeafes, 
are  admitted. 

MCCLIIL 

It  has  been  hitherto  the  method  of  our  Nofologifts 
to  divide  the  Spafmi  into  the  two  orders  of  Tonici  and 
Clonici,  Spaftici  and  Agitatorii  ;  or,  as  many  at  pre- 
fent  ufc  the  terms,  into  Spafrns  ftridly  fo  called,  and 
convuliions.  I  find,  however,  that  many,  and  indeed 
moft  of  the  difeafes  to  be  confidered  under  our  title  of 
Spafmodic  affections,  in  refpect  of  tonic  orCloric  con- 
tractions, are  of  a  mixed  kind  :  and,  therefore,  I  can- 
not follow  the  ufual  general  divilion  ;  but  have  at- 
tempted another,  by  arranging  the  feveral  Spafmodic 
difeafes  according  as  they  arlecl  the  feveral  functions, 
Animal,  Vital,  or  Natural. 


SECT.     I. 

OF  THE  SPASMODIC  AFFECTIONS  OF  THE 
ANIMAL  FUNCTIONS. 

MCCLIV. 

AGREEABLE  to  the  language  of  the  ancients,  the 
whole  of  the  difeafes  to  be  treated  of  in  this  feclion 
might  be  termed  fpajm;  and  many  of  the  moderns 
continue  to  apply  the  term  in  the  fame  manner  :  but  I 
think  it  convenient  to  diflinguim  the  terms  of  Spa  fin 
and  Convulfion,  by  applying  the  former,  ftrictly  to 

VOL.  II.  S  what 


138  PRACTICE 

what  has  been  called  the  Tonic;  and  the  latter,  to 
what  has  been  called  the  Clonk  Spafm.  There  is  cer- 
tainly a  foundation  for  the  ule  of  thofe  different  terms, 
as  there  is  a  remarkable  difference  in  the  ftate  of  the 
contraction  of  moving  fibres  upon  different  occaiions. 
This  I  have  indeed  pointed  out  before  in  my  treatife 
of  Phyfiology,  but  mutt  alfo  repeat  ii  here. 
MCCLV. 

In  the  exercife  of  the  feveral  functions  of  the  ariimal 
ceconcrny,  the  contractions  of  the  moving  fibres  are 
excited  by  the  will,  or  by  certain  other  caufes  fpecially 
appointed  by  nature  for  exciting  thofe  contractions ; 
and  thele  other  caufes  I  name  the  natural  caufes.  In 
a  (late  of  health,  the  moving  fibres  are  contracted  by 
the  power  of  the  will,  and  by  the  natural  caufes  only. 
At  the  fame  time  the  contractions  ufed  are  in  force 
and  velocity  regulated  by  the  will,  or  by  the  circum- 
ftances  of  the  natural  caufes ;  and  the  contractions, 
whether  produced  by  the  one  or  the  other,  are  always 
foon  fucceeded  by  a  flate  of  relaxation,  and  are  not 
repeated  but  when  the  power  of  the  will  or  of  the  na- 
tural caufes  is  again  applied. 

MCCLVL 

Such  are  the  conditions  of  the  action  of  the  moving 
fibres  in  a  ftate  of  health  ;  but  in  a  morbid  flate  the 
contractions  of  the  muicles  and  moving  fibres  ordina- 
rily depending  upon  the  will  are-  excited  without  the 
concurrence  of  the  will,  or  contrary  to  what  the  will 
intends;  and  in  the  other  functions  they  are  excited 
by  the  action  of  unufual  and  unnatural  caufes.  In 
both  cafes,  the  contradictions  produced  may  be  in  two 
different  ftates.  The  one  is,  when  the  contradictions 
are  to  a  more  violent  degree  than  is  ufual  in  health, 
and  are  neither  fucceeded  by  a  fpontaneons  relaxa- 
tion, nor  even  readily  yield  to  an  extenfion  either 
from  the  action  of  antagonist  mufcles,  or  from  other 
extending  powers  applied.  The  ftate  of  contractions 

is 


O  F     P  H  Y  S  I  C.  139 

is  what  has  been  called  a  tonic  fpafm,  and  is  what  I 
fhall  name  limply  and  ftrictly  a  fpafm.  The  other 
morbid  ilate  of  contraction  is,  when  they  are  fucceed- 
ed  by  a  relaxation,  but  are  immediately  again  repeated 
without  the  concurrence  of  the  will  or  of  the  repeti- 
tion of  natural  caufe*,  and  are  at  the  fame  time  com- 
monly, with  refpect  to  velocity  and  force,  more  vio- 
lent than  in  a  healthy  ftate.  This  (late  of  morbid 
contraction  is  what  has,  been  named  a  clonic  Jpafm,  and 
ivhat  I  fhall  name  (imply  and  flrictly  a  convuljion. 

In  this  fedion  I  ihall  follow  nearly  the  ufuai  divifion 
of  the  fpafmodic  difeafes  into  thofe  confiding  in  Spafm, 
and  thofe  confiding  in  convulflon;  but  it  may  not 
pernaps  be  in  mv  power  to  follow  fuch  divifion  ex- 
actly. 


CHAP.      I. 

OF     TETANUS. 

MCCLV1I. 

BOTH  Nofologifls  and  Practical  writers  have  dif- 
tinguifhed  Tetanic  complaints  into  the  feveral 
fpecies  of  Tetanus,  Opiflhotonos,  and  Emprofthoto- 
nos  ;  and  I  have  in  my  Nofology  put  the  Trifmus,  or 
Locked  Jaw,  as  a  genus  diilinct  from  the  Tetanus. — 
All  this,  however,  I  now  judge  to  be  improper  ;  and 
am  of  opinion,  that  ail  the  feveral  terms  mentioned, 
denote,  and  are  applicable  only  to,  different  degrees 
of  one  and  the  fame  difeafe  ;  the  hiftory  and  cure  of 
which  I  fhall  endeavour  to  deliver  in  this  chapter. 

MCCLVIII. 

Tetanic  complaints  may,  from  certain  caufes,  occur 
82  •  in 


i4o  PRACTICE 

ia  every  climate  that  we  are  acquainted  with  j  but  they 
occur  mod  frequently  in  the  warmed  climates,  and 
moil  commonly  in  the  warmed  feaibns  of  fuch  cli- 
mates. Thefe  complaints  affect  all  ages,  fexes,  tem- 
peraments, and  complexions.  The  caufes  from  whence 
they  commonly  proceed,  are  cold  and  moidure  appli- 
ed to  the  body  while  it  is  very  warm,  and  efpecially 
the  fudden  viciffitudes  or' heat  and  cold.  Or,  the  dif- 
eafe  is  produced  by  puncture,  lacerations,  or  other  le- 
fions  of  nerves  in  any  pare  of  the  body.  There  are, 
probably,  fame  other  caufes  of  this  difeafe  ;  but^they 
are  neither  difti  nelly  known,  nor  well  afcertained. 
Though  the  caufes  mentioned  do,  upon  occafion,  affect 
all  forts  of  perfons.  they  feem  however  to  attack  per- 
fons  of  middle  age  more  frequently  than  the  older  or 
younger, the  male  fex  more  frequently  than  the  female, 
and  the  robud  and  vigorous  more  frequently  than  the 
weaker. 

MCCL1X. 

If  the  difeafe  proceed  from  cold,  it  commonly  comes 
on  in  a  few  days  after  the  application  of  fuch  cold  ; 
but,  if  it  arife  from  a  puncture  or  other  lefion  of  a 
nerve,  the  difeafe  does  not  commonly  come  on  for 
many  days  after  the  lefion  has  happened,  very  often 
•when  there  is  neither  pain  nor  unealinefs  remaining  in 
the  wounded  or  hurt  part,  and  very  frequently  when 
the  wound  has  been  entirely  healed  up. 

MCCLX. 

The  difeafe  fometimes  comes  on  fuddenly  to  a  vio- 
lent degree,  but  more  generally  it  approaches  by  flow 
degrees  to  its  violent  date.  In  this  cafe  it -comes  on 
with  a  fenfc  of  diffnefs  in  the  back-part  of  the  neck, 
which,  gradually  increafmg,  renders  the  motion  of  the 
head  difficult  and  painful.  As  the  rigidity  of  the 
neck  comes  on  and  increafes,  there  is  commonly  at 
the  fame  time  a  fenfe  of  uneafinefs  felt  about  the  root 
of  the  tongue  ;  which  by  degrees,  becomes  a  difficul- 
ty 


OF     PHYSIC,  141 

ty  of  fwallowing,  and  at  length  an  entire  interruption 
of  it.  While  the  rigidity  of  the  neck  goes  on  increaf- 
ing,  there  arifes  a  pain,  often  violent,  at  the  lower 
end  of  the  fternum,  and  from  thence  mooting  into  the 
back.  When  this  pain  arifes,  all  the  mufcles  of  the 
neck,  and  particularly  thole  of  the  back  part  of  it,  are 
immediately  affected  with  fpafm,  pulling  the  head 
ftrongly  backwards.  At  the  fame  time,  the  mufcles 
that  pull  up  the  lower  jaw,  which  upon  the  firft  ap- 
proaches of  the  difeafe  were  affected  with  fome  fpaitic 
rigidity,  are  now  generally  affected  with  more  violent 
fpafm,  and  fet  the  teeth  fo  clofely  together,  that  they 
do  not  admit  of  the  fmalleft  opening. 

This  is  what  has  been  named  the  Locked  Jaw>  and 
is  often  the  principal  part  of  the  difeafe.  When  the 
difeafe  has  advanced  thus  far,  the  pain  at  the  bottom 
of  the  fternum  returns  very  frequently,  and  with  it  the 
fpafms  of  the  hind-neck  and  lower-jaw  a,re  renewed 
with  violence  and  much  pain.  As  the  difeafe  thus 
proceeds,  a  greater  number  of  mufcles  come  to  be  af- 
fected with  fpafms.  After  thofe  of  the  neck,  thofe 
along  the  whole  of  the  fpine  become  affected,  bending 
the  trunk  of  the  body  ftrongly  backwards ,  .and  this  13 
what  has  been  named  the  Opiftbotoncs. 

In  the  lower  extremities,  both  the  flexor  and  ex- 
tenfor  mufcles  are  commonly  at  the  fame  time  affected, 
and  keep  the  limbs  rigidly  extended.  Though  the 
cxtenfors  of  the  head  and  back  are  ufually  the  moil 
ftrongly  affected,  yet  the  flexors,  or  thofe  mufcles  of 
the  neck  that  pull  the  head  forward,  and  the  mufcles 
that  fhould  pull  down  the  lower  jaw,  are  often  at  the 
fame  time  ftrongly  affected  with  fpafm.  During  the 
whole  of  the  difeafe,  the  abdomin.il  mufcles  are  vio- 
lently affected  with  fpafm,  fo  that  the  belly  isftrorgiy 
retracted,  and  feels  hard  as  a  piece  of  board. 

At  length  the  flexors  of  the  head  and  trunk  become 
fo  ftrongly  affected  as  to  balance  the  extenfcrs,  and  to 

keep 


PRACTICE 

keep  the  head  and  trunk  ftraight,  and  rigidly  extend- 
ed, incapable  of  being  moved  in  any  way  ;  and  it  is 
to  this  date  the  term  Tetanus  has  been  ftridly  applied. 
At  the  fame  time,  the  arms,  little  affected  before,  are 
now  rigidly  extended  -y  the  whole  of  the  mufcles  be- 
longing to  them  being  affected  with  fpafms,  except 
thofe  that  move  the  fingers,  which  often  to  the  laft 
retain  fome  mobility.  The  tongue  alfo  long  retains 
its  mobility  ;  but  at  length  it  alfo  becomes  affected 
with' fpafms,  which,  attacking  certain  of  its  mufcles 
only,  often  thruft  it  violently  out  between  the  teeth. 

At  the  height  of  the  difeafe,  every  organ  of  volun- 
tary motion  feems  to  be  affected  ;  and  amongft  the 
reft,  the  mufcles  of  the  face.  The  forehead  is  drawn  up 
into  furrows,  the  eyes  fometimes  diflorted,  are  com- 
monly rigid,  and  immoveable  in  their  fockets;  the  nofe 
is  drawn  up,  and  the  cheeks  are  drawn  backwards  to- 
wards the  ears,  fo  that  the  whole  countenance  expreff- 
es/the  moil  violent  grinning.  Under  thefe  univerfal 
fpafms,  a  violent  convulilon  commonly  comes  on,  and 
puts  an  end  to  life. 

MCCLXI. 

Thefe  fpafms  are  every  where  attended  with  moil 
violent  pains.  The  utmofl  violence  of  fpafm  is,  how- 
ever, not  conftant ;  but,  after  fubfifting  for  a  minute 
or  two,  the  mufcles  admit  of  fome  remiflion  of  their 
contraction,  although  of  no  fuch  relaxation  as  can  al- 
low the  action  of  their  antagonifls.  This  remiffion  of 
contraction  gives  alfo  fome  remiflion  of  pain ;  but 
neither  is  of  long  duration.  From  time  to  time,  the 
violent  contractions  and  pains  are  renewed  fometimes 
every  ten  or  fifteen  minutes,  and  that  often  without 
any  evident  exciting  caufe.  But  fuch  exciting  caufes 
frequently  occur  ;  for  almolt  every  attempt  to  motion, 
as  attempting  a  change  of  pofture,  endeavouring  to 
f wallow,  and  evtn  to  fpeak,  fometimes  gives  occafion 
to  a  renewal  of  the  fpafms  over  the  whole  body. 

MCCLXII. 


OF     PHYSIC. 

MCCLXII. 

The  attacks  of  this  difeafe  are  feldom  attended 
with  any  fever.  When  the  fpafms  are  general  and 
violent,  the  pulfe  is  contracted,  hurried,  and  irregu- 
lar ;  and  the  refpiration  is  afft-cted  in  like  manner : 
but,  during  the  remiffion,  both  the  pulfe  and  refpira- 
tion ufually  return  to  their  natural  ftate.  The  heat  of 
the  body  is  commonly  not  increafed  ;  frequently  the 
face  is  pale,  with  a  cold  fweat  upon  it ;  and  very  ofcen 
the  extremities  are  cold,  with  a  cold  fweat  over  the 
whole  body.  When,  however,  the  fpafms  are  fre- 
quent and  violent,  the  pulfe  is  fometimes  more  full  and 
frequent  than  natural ;  the  face  is  flufhed,  and  a  warm 
fweat  is  forced  out  over  the  whole  body. 
MCCLXIIL 

Although  fever  be  not  a  comtant  attendant  of  this 
difeafe,  cfpecially  when  arifmg  from  a  leiion  of  nerves  ; 
yet,  in  thofe  cafes  proceeding  from  cold,  a  fever  fome- 
times has  fupervened,  and  is  faid  to  have  been  at- 
tended with  inflammatory  fymptoms.  Blood  has  been 
often  drawn  in  this  difeafe,  but  it  never  exhibits  any 
inflammatory  cruft ;  and  all  accounts  feem  to  agree, 
that  the  blood  drawn  feems  to  be  of  a  loofer  texture 
than  ordinary,  and  that  it  does  not  coagulate  in  the 
ufual  manner. 

MCCLXIV. 

In  this  difeafe  the  head  is  feldom  affected  with  deli- 
rium or  even  confufion  of  thought,  till  the  lafl  ftage 
of  it ;  when,  by  the  repeated  fhocks  of  a  violent 
diftemper,  every  function  of  the  fyflcm  is  greatly  dif- 
ordered. 

MCCLXV. 

It  is  no  leis  extraordinary,  that,  in  this  violent  dif- 
eafe, the  natural  functions  are  not  either  immediately 
or  confiderably  affected.  Vomitings  fometimes  ap- 
pear early  in  the  difeafe,  but  commonly  they  are  not 
continued  ;  and  it  is  ufual  enough  for  the  appetite  of 

hunger 


144  PRACTICE 

hunger  to  remain  through  the  whole  courfc  of  the  dif- 
eafe  ;  and  what  food  happens  to  be  taken  down,  feems 
to  be  regularly  enough  digefted.  The  excretions  are 
fometimes  affected,  but  not  always.  The  urine  is 
fometimes  fuppreffed,  or  is  voided  with  difficulty  and 
pain.  The  belly  is  coflive:  but,  as  we  have  hardly 
any  accounts  excepting  of  thofe  cafes  in  which  opiates 
have  been  largely  employed,  it  is  uncertain  whether 
the  coftivenefs  has  been  the  effect  of  the  opiates  or  of 
the  difeafe.  In  feveral  instances  of  this  difeafe,  a  mi- 
liary  eruption  has  appeared  upon  the  fkin  ;  but  whe- 
ther this  be  a  fymptom  of  the  difeafe,  or  the  effect  of  a 
certain  treatment  of  it,  is  undetermined.  In  the  mean 
while,  it  has  not  been  obferved  to  denote  either  fafety 
or  danger,  or  to  have  any  effect  in  changing  the  courfe 
of  the  diilemper. 

MCCLXVI. 

This  difeafe  has  generally  proved  fatal ;  and  this 
indeed  may  be  juftly  fuppofed  to  be  the  confequence 
of  its  nature:  but,  as  we  know,  that,  till  very  lately, 
phyiicians  were  not  well  acquainted  with  a  proper  me- 
thod of  cure ;  and  that  fince  a  more  proper  method 
has  been  known  and  practifed,  many  have  recovered 
from  this  difeafe  ;  it  may  be  therefore  concluded,  that 
the  fatal  tendency  of  it  is  not  fo  unavoidable  as  has 
been  imagined. 

In  judging  of  the  tendency  of  this  difeafe,  in  parti- 
cular cafes,  we  may  remark,  that,  when  arifing  from 
lefions  of  the  nerves,  it  is  commonly  more  violent,  and 
of  more  difficult  cure,  than  when  proceeding  from 
cold  ;  that  the  difeafe  which  comes  on  fuddenly,  and 
advances  quickly  to  a  violent  degree,  is  always  more 
dangerous  than  that  which  is  flower  in  its  progrefs. 
Accordingly,  the  difeafe  often  proves  fatal  before  the 
fourth  day  ;  and,  when  a  patient  has  palled  -this  peri- 
od, he  may  be  fuppofed  to  be  in  greater  fafety,  and  iri 
general  the  difeafe  is  the  fafcr  the  longer  it  lias  con- 
tinued. 


O  F    P  H  Y  S  I  C.  145 

tinued.  It  is  however,  to  be  particularly  obferved, 
that,  even  for  many  days  after  the  fourth,  the  difeafe 
continues  to  be  dangerous  ;  and,  even  after  fome  con- 
fiderable  abatement  of  its  force,  it  is  ready  to  recur 
again  with  its  former  violence  and  danger.  It  never 
admits  of  any  fudden,  or  what  may  be  called  a  critical 
folution  ;  but  always  recedes  by  degrees  only,  and  it  is 
often  very  long  before  the  whole  of  the  fymptoms 
difappear. 

MCCLXVII, 

From  the  hiflory  of  the  difeafe  now  defcribed,  it 
will  be  evident,  that  there  is  no  room  for  diftinguilh- 
ing  the  tetanus,  opi/ihotonos,  and  trljmut  or  locked  jaw, 
as  different  fpecies  of  this  difeafe,  iince  they  all  arife 
from  the  fame  caufes,  and  are  almofl  conflantly  con- 
joined in  the  fame  perfon,  I  have  no  doubt  that  the 
emprofthotonos  belongs  alfo  to  the  fame  genus ;  and  as 
the  ancients  have  frequently  mentioned  it,  we  can  have 
no  doubt  of  its  having  occurred ;  but,  at  the  fame 
time,  it  is  certainly  in  thefe  days  a  rare  occurrence  j 
and,  as  I  have  never  feen  it,  nor  find  any  hiftcries  in 
which  this  particular  ftate  of  the  fpafms  is  faid  to  have 
prevailed,  I  cannot  mention  the  other  circumilances 
which  particularly  attend  it,  and  may  difting'uifh  it 
from  the  other  varieties  of  tetanic  complaints, 
MCCLXVIII. 

This  difeafe  has  put  on  Hill  a  different  form  from 
any  of  thofe  above  mentioned.  The  fpafins  have  been 
fometimes  confined  to  one  fide  of  the  body  only,  and 
which  bend  it  ftrongly  to  that  fide.  This  is  what  has 
been  named  by  Sauvages  the.  tetanus  Lateralis,  and 
by  fome  late  writers  the  Pkuroftbctonos.  This  form 
of  the  difeafe  has  certainly  appeared  very  feldom  ; 
and,  in  any  of  the  accounts  given  of  it,  I  cannot  find 
any  circumftances  that  would  lead  me  to  confider  it  as 
any  other  than  a  variety  of  the  fpecies  already  menti- 
oned, or  to  take  further  notice  of  it  here. 

VOL,  II.  T  MCCLXIX 


146  PRACTICE 

MCCLXC£. 

The  pathology  of  this  difeafc  I  cannot  in  any  mea- 
fure  attempt ;  as  the  ftructure  of  moving  fibres,  the 
ftate  of  them  under  different  degrees  of  contradion, 
and  particularly  the  ftate  of  the  fenforium,  as  varioufly 
determining  the  motion  of  the  nervous  power,  are  all 
matters  very  imperfectly,  or  not  at  all,  known  to  me. 
In  fuch  a  fituation,  therefore,  the  endeavouring  to  give 
any  rules  of  pra&ice,  upon  a  fcientific  plan,  .appears 
to  me  vain  and  fruitlefs ;  and  towards  directing  the 
cure  of  this  difeafe,  we  mull  be  fatisfied  with  having 
learned  fomething  ufeful  from  analogy,  confirmed  by 
experience. 

MCCLXX. 

When  the  difeafe  is  known  to  arife  from  the  lefioa 
of  a  nerve  in  any  part  of  the  body,  the  firit,  and,  as  I 
judge,  the  moft  important  flep  to  be  taken  towards  the 
cure,  is,  by  every  poffible  means,  to  cut  off  that  part 
from  all  communication  with  the  fenforium,  either  by 
cutting  through  the  nerves  in  their  courfe,  or  perhaps- 
by  deftroying,  to  a  certain  length,  their  affected  part 
or  extremity. 

MCCLXXI. 

When  the  cure  of  the  difeafe  is  to  be  attempted  by- 
medicine,  experience  has  taught  us  that  opium  has 
often  proved  an  effectual  remedy  ;  but  that,  to  render 
it  fuch,  it  mufl  be  given  in  much  larger  quantities 
than  have  been  employed  in  any  other  cafe  ;  and  in 
thefe  larger  quantities,  it  may,  in  this  difeafe,  be  given 
more  fafely  than  the  body  has  been  known  to  bear  in 
any  other  condition.  The  practice  has  been,  to  give 
the  opium  either  in  a  folid  or  a  liquid  form,  not  in 
any  very  large  dofe  at  once,  but  in  moderate  dofes, 
frequently  repeated,  at  the  interval  of  one,  two,  three 
or  more  hours,  as  the  violence  of  the  fymptorns  feems 
to  require*.  Even  when  large  quantities  have  been 

given 

*  Though  the  exhibition  of  opium  in  Tetanus  has  been  the  mod 


O  F    P  H  Y  S  I  C.  147 

given  in  this  way,  it  appears  that  the  opium  does  not 
operate  here  in  the  fame  manner  as  in  moft  other  ca- 
fes; for,  though  it  procures  fome  remiffion  of  the  fpafms 
and  pains,  it  hardly  induces  any  fleep,  or  occalions  that 
ftupor,  intoxication,  or  delirium,  which  it  often  does 
in  other  circumflances,  when  much  fmaller  quantities 
only  have  been  given.  Jt  is  therefore  very  properly 
obferved,  that,  in  tetanic  affections,  as  the  opium 
fliows  none  of  thofe  affections  by  which  it  may  endan- 
ger life,  there  is  little  or  no  reafon  for  being  fparing  in 
the  exhibition  of  it ;  and  it  may  be  given,  probably 
ihould  be  given,  as  largely  and  as  fail  as  the  fymptoms 
of  the  difeafe  may  feeui  to  demand. 

It  is  paiticularly  to  be  obferved,  that  though  the 
firft  exhibitions  of  the  opium  may  have  produced 
fome  re  million  of  the  fymptoms,  yet  the  eifecls  of 
opium  do  not  long  continue  in  the  fyftem  \  and  this 

T  2  difeafe 

univerfal  practice,  it  muft  nevertheless  be  acknowledged,  that,  in  ma- 
ny, if  not  in  moft  cafes,  it  has  been  ineffectual.  The  difeafe,  indeed 
is  in^gensrai  fatal ;  but,  in  molt  of  the  cafes  that  terminated  happi- 
ly, opium  has  been  given,  as  the  Author  defcribes,  cith-er  in  large 
dofes,  or  frequently  repeated  fmall  dofes,  we  muft  ncceflarily  conclude 
that  the  practice  ought  to  be  followed. 

I  have  fecn  only  one  cafe  of  Tetanus  ;  it  proceeded  from  a  wound 
which  a  carpenter  received  in  the  wrift  of  his  left  arm  with  a  faw. 
The  inflammation  was  violent :  the  ftiffnefs  of  the  neck  at  firft  ap- 
peared on  the  third  day,  when  the  inflammation  began  to  abate  after 
bleeding,  and  the  application  of  emollient  poultices  j  the  pulfe  was 
weak  and  fmall ;  thirty  drops  of  laudanum  were  given  ;  the  fymp- 
toms increafed  ;  and,  on  the  day  following,  the  jaw  became  fixed. 
Thirty  drops  of  laudanum  were  repeated  ;  and  the  fyraptoms  abat- 
ing within  two  hours  after  its  exhibition,  indicated  a  repetition  of 
the  dofe,  which,  from  its  good  effects,  was  a  fouith  time  repeated 
the  fame  day.  The  wound  fuppurated  ;  and  the  day  following,  with 
two  dofes  of  forty  drops  of  laudanum,  the  fymptoms  of  Tetanus 
wholly  difappeared,  but  left  the  patient  in  a  moil  debilitated  ftate. 
A  coftivenefs  fupervened,  that  was  removed  with  the  ufe  of  manna 
and  Glauber's  falts  occafionally  :  The  patient  was  nourished  with 
rich  broths  and  wine  ;  but  he  did  not  recover  his  former  ftrength 
till  after  fix  weeks,  although  the  wound  was  healed  in  half  that  time* 


14$  PRACTICE 

difeafe  being  for  fonie  time  ready  to  recur,  it  is  com- 
inonly  very  neceffary,  by  the  time  that  the  effedts  of 
the  opium  given  may  be  fuppofed  to  be  wearing  off, 
and  efpecially  upon  the  leal!  appearance  of  a  return 
of  thefpafms,  to  repeat  the  exhibition  of  the  opium  in 
the  fame  quantities  as  before.  This  practice  is  to  be 
continued  while  the  difeafe  continues  to  (how  any  dif- 
pofition  to  return ;  and  it  is  only  after  the  difeafe  has 
already  fubliited  for  fome  time,  and  when  coniiderable 
and  long ~ continued  remiffions  have  taken  place,  that 
the  dofes  of  the  opium  may  be  dirninifhed,  and  the 
intervals  of  exhibiting  them  be  more  coniiderable. 
MCCLXXil. 

The  adminiftering  of  opium  in  this  manner,  has  in 
many  cafes  been  iiiccefsful;  and  probably  would  have 
been  equally  fo  in  many. others,  if  the  opium  had  nee 
been  too  fparingly  employed,  either  from  the  timidity 
of  practitioners,  or  from  its.  exhibition  being  prevent- 
ed by  that  interruption  of  deglutition  which  fo  often 
attends  this"  difeafe.  This  latter  circumflance  directs, 
that  the  medicine  fhould  be  immediately  and  largely 
employed  upon  the  firft  approach  of  the  difeafe,  be- 
fore the  deglutition  becomes  difficult ;  or  that,  if  this 
opportunity  be  loft,  the  medicine,  in  fuiScient  quan- 
tity, and  with  due  frequency,  ihould  be  thrown  into 
the  body  by  glyfter ;  which,  however,  does  not  feem 
to  have  been  hitherto  often  pradifed. 
MCCJ.XXUI. 

•It  is  highly  probable,  that,  in  this  difeafe,  the  intcf- 
tines  areaifedted  with  the  fpafni  that  prevails  fo  much 
in  other  parts  of  the  fyftem  ;  and  therefore,  that  coitive- 
nefs  occurs  here  as  a  fymptom  "of  the  difeafe*.  It  is 
probably  alfo  increafed  by  the  opium,  which  is  here 
fo  largely  employed  j  and,  from  whichever  of  thefe 

caufes 

i 

*  This  fymptom  occurred  in  the  cafe  mentioned  in  the  preceding 
note. 


OF    PHYSIC,  149 

caufes  it  arifes,  it  certainly  muft  be  held  to  aggravate 
the  difeafe,  and  that  a  relaxation  of  the  inteftinal  ca- 
nal will  contribute  to  a  relaxation  of  the  fpafms  elfe- 
where.  This  conlideration  directs  the  frequent  exhi- 
bition of  laxatives  while  the  power  of  deglutition  re- 
mains, or  the  frequent  exhibition  of  glyfters  when  it 
does  not ;  and  the  good  effects  of  both  have  been  fre- 
quently obferved. 

MCCLXXIV. 

It  has  been  with  fo.me  probability  fuppofcd,  that 
the  operation  of  opium  in  this  difeafe,  may  be  much 
affifted  by  joining  with  itforne  other  of  the  moil  pow- 
erful antifpafrnodics.  The  mod  promiling  are  mufk 
and  camphire  ;  and  fome  practitioners  have  been  of 
opinion,  that  the  former  has  proved  very  ufeful  in  te- 
tanic complaints.  But,  whether  it  be  from  its  not 
having  been  employed  of  a  genuine  kind,  or  in  fuffi- 
cient  quantity,  the  great  advantage  and  propriety  of 
its  ufc  are  not  yet  clearly  ascertained.  It  appears  to 
me  probable,  that  analogous  to  what  happens  with  re- 
fpecl  to  opium,  both  mufk  and  camphire  might  be  em- 
ployed in  this  difeafe,  in  much  larger  quantities  than 
they  commonly  have  been  in  other  cafes. 
MCCLXXV. 

Warm  bathing  has  been  commonly  employed  as  a 
remedy  in  this  difeafe,  and  often  with  advantage  ;  but, 
fo  far  as  I  know,  it  has  not  alone  proved  a  cure  ;  and, 
in  fome  cafes,  whether  it  be  from  the  motion  of  the 
body  here  required,  exciting  the  fpafms,  or  from  the 
fear  of  the  bath,  which  fome  perfons  were  feized  with, 
I  cannot  determine  ;  but  it  is  allowed,  that  the  warm 
bath  hath  in  fome  cafes  done  harm,  und  even  occafi- 
oned  death.  Partial  fomentations  have  been  much 
commended,  and,  I  believe,  upon  good  grounds  :  And 
I  have  no  doubt  but  that  fomentations  of  the  feet  and 
legs,  as  we  now  ufually  apply  them  in  fevers,  might, 

without 


*5°  PRACTICE 

without  much  (lirring  of  the  patient,  be  very  aflidu- 
ouily  employed  with  advantage. 
MCCLXXVI. 

Un&uous  applications  were  very  frequently  employ- 
ed in  this  difcafe  by  the  ancients  :  and  fome  modern 
practitioners  have  confidered  them  as  very  ufeful. 
Their  efFecls,  however,  have  nor  appeared  to  be  con- 
iiderablej  and,  as  a  weak  auxiliary  only,  attended 
with  fome  inconvenience,  they  have  been  very  much 
neglected  by  the  Bntifh  practitioners. 
MCCLXXVII. 

Bleeding  has  been  formerly  employed  in  this  dif* 
eafe  ;  but  of  late  it  has  been  found  prejudicial,  except- 
ing in  a  few  cafes,  where,  in  plethoric  habits,  a  fever 
has  fupcrvened.  In  general,  the  itate  of  men's  bodies 
in  warm  climates  is  unfavourable  to  t>lood-letting  : 
and,  if  we  may  form  indications  from  the  Hate  of  the 
blood  drawn  out  of  the  veins,  the  ftate  of  this  in  teta- 
nic difeafes  would  forbid  bleeding  in  them, 
MCCLXXVHL 

Bliftering  alfo  has  been  formerly  employed  in  this 
difeafe  ;  .but  feveral  practitioners  ailert,  that  bliflers 
are  conftantly  hurtful,,  and  they  are  now  generally 
omitted. 

MCCLXXIX. 

Thefe  are  the  practices  that  hitherto  have  been  ge- 
nerally employed  ;  but  of  late  we  are  informed  by  fe- 
veral Weil  India  practitioners,  that  in  many  inflanccs 
they  have  employed  mercury  with  advantage.  We 
are  told,  that  it  rnuft  be  employed  early  in  the  dif- 
eafe ;  that  it  is  moft  conveniently  adminillcred  by 
unction,  and  mould  be  applied  in  that  way  in  large 
quantities,  fo  that  thebooy  may  be  foon  filled  with  it, 
and  a  falivation  raifed,  which  is  to  be  continued  till 
the  fymptoms  yield.  Whether  this  method  alone  be 
generally  fufficient  for  the  cure  of  this  difeafe,  or  if  it 
may  be  affided  by  the  ufc  of  opium,  and  require  this 

iu 


OF    PHYSIC.  151 

in  a  certain  meafure  to  be  joined  with  it,  I  have  not 
yet  certainly  learned. 

MCCLXXX. 

I  have  been  further  informed,  that  the  tetanus,  in 
all  its  different  degrees,  has  been  cured  by  giving  in- 
ternally the  Piflelaeum  Barbadenfe,  or,  as  it  is  vulgar- 
ly called,  the  Barbadoes  Tar.  1  think  it  proper  to 
take  notice  of  this  here,  although  I  arnnot  exactly  in- 
formed what  quantities  of  this  medicine  are  to  be  giv- 
en, or  in  what  circumitances  of  the  difeafe  it  is  moll 
properly  to  be  employed. 

MCCLXXX.* 

In  the  former  edition  of  this  work,  among  the  reme- 
dies of  tetanus  I  did  not  mention  the  ufe  of  cold  ba- 
thing ;  becaufe,  though  I  had  heard  of  this,  I  was  net 
informed  of  fuch  frequent  employment  of  it  as  might 
confirm  my  opinion  of  its  general  efficacy  :  nor  was  I 
fufficiently  informed  of  the  ordinary  and  proper  ad- 
miniftration  of  it.  But  now,  from  the  information  of 
many  judicious  practitioners  who  have  frequently  em- 
ployed it,  I  can  fay,  that  it  is  a  remedy  which  in_nu- 
merous  trials  has  been  found  to  be  of  great  fervice  in 
this  difeafe;  and  that,  while  the  ufe  of  the  ambiguous 
remedy  of  warm  bathing  is  entirely  laid  afide,  the  ufe 
of  cold  bathing  is  over  the  whole  of  the  Weft  Indies 
commonly  employed.  The  adminiftration  of  it  is 
fometimes  by  bathing  the  perfon  in  the  fea,  or  more 
frequently  by  throwing  eold  water  from  a  bafon  or 
bucket  upon  the  patient's  body,  and  over  the  whole 
of  it :  when  this  is  done,  the  body  is  carefully  wiped 
dry,  wrapped  in  blankets,  and  laid  a-bed,  and  at  the 
fame  time  a  large  dofe  of  an  opiate  is  given.  By  thefe 
means  a  coniiderable  remiflion  of  the  fyrnptoms  is  ob- 
tained ;  but  this  remiflion,  at  firft,  does  not  common- 
ly remain  long,  but  returning  again  in  a  few  hours, 

the 

*  The  Paragraphs  were  thus  numbered  in  the  la  ft  edition. 


i'5a  PRACTICE 

the  repetition  both  of  the  bathing  and  the  opiate  be- 
comes neceiTary.  By  thefe  repetitions,  however, 
longer  intervals  of  eafe  are  obtained,  and  at  length  the 
difeafe  is  entirely  cured  ;  mid  this  even  happens  fome- 
tiraes  very  quickly.  I  have  only  to  add,  that  it  does 
not  appear  to  me,  from  any  accounts  that  I  have  yet 
had,  that  the  cold  bathing  has  been  fo  frequently  em- 
ployed, or  has  been  Lund  fo  commonly  fuccefsful  in 
the  cafes  or  tetanus  in  confequence  of  wounds,  as  in 
thofe  from  the  application  of  cold. 
MCCLXXXL 

Before  concluding  this  chapter,  it  is  proper  for  me 
to  take  fome  notice  of  that  peculiar  cafe  of  the  teta- 
nus, or  trifmus,  which  attacks  certain  infants  ibon  af- 
ter their  birth,  and  has  been  properly  enough  named 
the  Trifmus  Nafcentium.  From  the  fubjccls  it  af- 
fects, it  feems  to  be  a  peculiar  difeafe  :  for  thefe  are 
infants  not  above  two  weeks,  and  commonly  before 
they  are  nine  days,  old  ;  infomuch  that,  in  countries 
where  the  difeafe  is  frequent,  if  children  pafs  the  peri- 
od now  mentioned,  they  are  considered  as  fecure  a- 
gainft  its  attacks.  The  fymptom  of  it  chiefly  taken 
notice  of,  is  the  trifmus,  or  locked  jaw,  which  is  by 
the  vulgar  improperly  named  the  Falling  of  the  Jaw. 
But  this  is  not  the  only  fymptom,  as,  for  the  mod  part, 
it  has  all  the  fame  fymptoms  as  the  Opifthotonos  and 
Tetanus  ftiictly  fo  called,  and  which  occur  in  the  o- 
ther  varieties  of  the  tetanic  complaints  above  defcrib- 
ed.  Like  the  other  varieties  of  tetanus,  this  is  moil 
frequent  in  warm  climates,  but  it  is  not,  like  thole  a-' 
riling  from  the  application  of  cold,  entirely  confined 
to  fuch  warm  climates,  as  iriftances  of  it  have  occur- 
red in  moil  of  the  northern  countries  of  Europe.  In 
thefe  latter  it  feems  to  be  more  frequent  in  certain  dif- 
tricls  than  in  others  ;  but  in  what  manner  limited,  I 
cannot  determine.  It  feems  to  be  more  frequent 
in  Switzerland  than  in  France.  I  am  informed  of  its 

frequently 


O  F    P  H  Y  S  I  C.  133 

frequently  occurring  in  the  Highlands  of  Scotland  ; 
but  I  have  never  met  with  any  initance  oiit  in  the 
low  country.  The  particular  caufes  of  it  are  not  well 
known ;  and  various  conjectures  have  been  offer- 
ed ;  but  none  of  them  are  fatisfying.  It  is  a  dlfeafe 
that  has  been  aimoft  conftantly  fatal;  and  this,  alfo, 
commonly  in  the  courfe  of  a  few  days.  The  women 
are  fo  much  perfuaded  of  its  inevitable  fatality,  that 
they  feldom  or  never  call  for  the  affiflance  of  our  art. 
This  has  occalioned  our  being  little  acquainted  with 
the  hiftory  of  the  difeafe,  or  with  the  effects  of  reme- 
dies in  it.  Analogy,  however,  would  lead  us  to  em- 
ploy the  fame  remedies  that  have  proved  ufeful  in  the 
other  cafes  of  tetanus  :  and  the  few  experiments  that 
are  yet  recorded,  feem  to  approve  of  fuch  a  practice. 


CHAP.        II. 

OF      EPILEPSY. 

MCCLXXXII. 

IN  what  fenfe  I  ufe  the  term  Convulfion,  I  have  ex- 
plained above  in  MCCLVI. 

The  convuliions  that  affect  the  human  body  are 
in  feveral  refpects  various ;  but  I  am  to  confider  here 
only  the  chief  and  moft  frequent  form  in  which  they 
appear,  and  which  is  in  the  difeafe  named  Epilepfy. 
This  may  be  defined,  as  confiding  in  convulfions  of 
the  greater  part  of  the  mufcles  of  voluntary  motion, 
attended  with  a  lofs  of  fenfe,  and  ending  in  a  Hate  of 
infenfibility  and  feeming  fleep. 

MCCLXXXIII. 

The  general  form  or  principal  circumflances  of  this 
VOL.  II.  U  difeafe, 


354  PRACTICE 

difeafe,  are  much  the  fame  in  all  the  different  pen' 
whom  it  affects.  It  comes  by  tits,  which  often  attacks 
perfons  Jfecmingly  in  perfect  health  ;  and,  after  lading 
forfome  time,  pals  off,  and  leave  the  perfons  again  in 
theiitafual  Rate.  Thefe  fits  are  fometimes  preceded 
by  certain  fymptoms,  which  to  perfons  who  have  be- 
fore experienced  fuch  a  fit,  may  give  notice  or  its  ap- 
proach, as  we  fhall  hereafter  explain  ;  btit  even  thefe 
preludes  do  not-  commonly  occur  long  before  the  for- 
mal attack,  which  in  moll  cafes  comes  on  fuddenly 
without  any  fuch  warning. 

The  per  fen  attacked  lofes  fuddenly  all  fen  fe  and 
power  of  motion  ;  fo  that,  if  {landing,  he  falls  imme- 
diately,, or  perhaps,  with  convulfions,  is  thrown  to 
the  ground.  In  that  fituation  he  is  agitated  with  vi- 
olent convulfions,  varioufly  moving  his  limbs  and  the 
trunk  of  his  body*  Commonly  the  Jimbs  on  one 
fide  of  the  body  are  more  violently  orfcore  conflder- 
ably  agitated  than  thofe  upon  the  orher.  In  all  cafes 
the  mufcles  of  the  face  and  eyes  are  much  affected, 
exhibiting  various  and  violent  diftortions  of  the  coun- 
tenance. The  tongue  is  often  affected,  and  thruft 
out  of  the  mouth  ;  while  the  mufcles  of  the  lower  jaw 
are  aifo  affected ;  and,  {hutting  the  mouth  with  vio- 
lence while  the  tongue  is  thruft  out  between  the  teeth, 
that  is  often  grievoufly  wounded. 

While  thefe  convulfions  continue,  there  is  common- 
ly at  the  fame  time  a  frothy  moifture  iffuing  from  the 
mouth.  Thefe  convulfions  have  for  fome  moments 
feme  remiffions,  but  afe  fuddenly  again  renewed  with 
great  violence.  Generally,  after  no  long  time,  the 
conviilliorrs 'cfeafe  altogether;  and  the  perfon  for  fome 
time  remains  without  motion,  but  in  a  ftate  of  abtb- 
lute  infeniibility,  -and  under  the  appearance  of  a  pro- 
found fleep.  After  fome  continuance  of  this  feeming 
fieep,  the  perfon  fometimcs'fuddenly,  but  for  the  moft 
part  by  degrees  only,  recovers  his  fenies  and  power 

of 


O  F    P  H  Y  S  I  C.  155 

of  motion  ;  but  without  any  memory  of  what  had  pafT- 
ed  from  hi?  being  firll  ieized  with  the  fit.  Daring 
the  convulfions,  the  puUe  and  refpiration  are  hurried 
and  irregular;  bat,  when  the  conyulficns  ceafe,  they 
return  to  their  ufual  regularity  and  healthy  ftate. 

This  is  the  general  form  of  the  difeafe;  and  it  va- 
ries only  in  different  perfons,  or  on  different  accafions 
in  the  fame  perfon,  by  the  phe-nom-ena  mentioned  be- 
ing more  or  Icfs  violent,  or  by  their  being  of  longer  or 
Sorter  duration. 

MCCLXXXIV. 

With  refped:  to  the  proximate  caufe  of  this  difeafe,^ 
I  might  fay,  that  it  is  an  affection  of  the  energy  of  the 
brain,  which,  ordinarily  under  the  direction  of  the 
will,  is  here,  without  any  concurrence  of  it,  impelled 
by  preternatural  caufes.  But  I  could  go  no  farther : 
For,  as  to  what  is  the  mechanical  condition  of  the 
brain  in  the  ordinary  exertions  of  the  will,  I  have  no 
diftindt  knowledge  ;  and  therefore  mud  be  alfo  igno- 
rant of  the  preternatural  ftate  of  the  fame  energy  of 
the  brain  under  the  irregular  motions  here  produced. 
To  form,  therefore,  the  indications  of  a  cure,  from  a 
knowledge  of  the  proximate  caufe  of  this  difeafe,  I 
mull  not  attempt,  but,  from  a  diligent  attention  to 
the  remote  caufrs  which  firft  induce  and  occasionally 
excite  the  difeafe,  I  think  we  may  often  obtain  fome 
ufeful  directions  for  its  cure;  It  mail  therefore  be  my 
bufinefs  now,  to  point  out  and  enumerate  thefe  re« 
mote  caufes  as  well  as  I  can. 

MCCLXXXV. 

The  remote  caufes  of  epilepfy  may  be  confidered  as 
occaiional  or  predifponent.  There  are,  indeed,  cer- 
tain remote  caufes  w^hich  acl  independently  of  any 
predifpofition ;  but5  as  we  cannot  always  diilinguidi 
thefe  from  the  others,  I  fhall  confider  the  whole  under 
the  ufual  titles  o^Occafional  or  Predifponent. 

U  %  MCCLXXXVI. 


I56  PRACTICE 

MCCLXXXVI. 

The  occafional  caufes,  may,  I  think,  be  properly  re- 
ferred to  two  general  heads  ;  ihejir/t  being  of  thofe 
which  feem  to  ad  by  directly  ftimulating  and  exciting 
the  energy  of  the  brain  ;  and  the  fecond,  of  thole 
which  feem  to  act  by  weakening  the  fame.  With 
refpect  to  both,  for  the  brevity  of  expreffing  a  fact, 
without  meaning  to  explain  the  manner  in  which  it 
is  brought  about,  I  fliall  life  the  terms  of  Excitement 
and  Collapfe.  And  though  it  be  true,  that  with  re- 
fpcct  to  forne  of  the  caufes  I  am  to  mention,  it  may  be 
a  little  uncertain  whether  they  act  in  the  one  way  or 
the  other,  that  does  not  render  it  improper  for  us  to 
mark,  with  refpect  to  others,  the  mode  of  their  operat- 
ing, wherever  we  can  do  it  clearly,  as  the  doing  fa 
may  often  be  of  ufe  in  directing  our  practice. 
MCCLXXXV1I. 

Firft,  then,  of  the  occafionai  caufes  acting  by  excite* 
ment :  They  are  either  fuch  as  act  immediately  and 
directly  upon  the  brain  itfelf ;  or  thofe  which  are  firft 
applied  to  the  other  parts  of  the  body,  and  are  from 
thence  communicated  to  die  brain. 
MCCLXXXV1II. 

The  caufes  of  excitement  immediately  and  directly 
applied  to  the  brain,  may  be  referred  to  the  four  heads 
of,  i.  Mechanical  Stimulants  ;  2.  Chemical  Stimu- 
lants;  3.  Mental  Stimulants;  and  4.  The  peculiar 
Stimulus  of  Over-diftention. 

MCCLXXXIX. 

The  mechanical  ftimulams  may  be,  wounding  in- 
ftruments  penetrating  the  cranium,  and  entering  the 
fubftance  of  the  brain  ;  or  fplinters  of  a  fractured  cra- 
nium, operating  in  the  fame  manner;  or  iliarp-point- 
ed  oflifications,  either  arifing  from  the  internal  fin  face 
of  the  cranium,  or  formed  in  the  membranes  of  the 
brain. 

MCCXC. 


OF     PHYSIC.  157 

MCCXC. 

The  chemical  {timulants  (MCCLXXXVIII.)  maybe 
fluids  from  various  caufcs  lodged  in  certain  parts  of 
the  brain,  and  become  acrid  by  ftagnution  or  other- 
wife. 

MCCXCI. 

The  mental  irritations  aduig  by  excitement,  are, 
all  violent  emotions  of  the  adtive  kind,  fuch  as  joy 
and  anger.  The  firll  of  thefe  is  manueiuy  an  excit- 
ing power,  acting  -ftrongly,  and  immediately,  on  the 
energy  of  the  brain.  The  fecond  is  manifeitiy,  alfo, 
a  power  acting  in  the  fame  manner.  But  it  mull  be 
remarked,  that  it  is  not  in  this  manner  alone  anger 
produces  its  effects  :  for  it  ads,  alfo,  itrongly  on  the 
fanguiferous  fyitem,  and  may  be  a  means  of  giving 
the  ftimulus  of  over-detention  ;  as,  under  a  fit  of  an- 
ger, the  blood  is  impelled  into  the  veifcls  of  the  head 
with  violence,  and  in  a  larger  quantity. 
MCCXCII. 

Under  the  head  of  Mental  Irritations,  is  to  be 
mentioned,  the  fight  of  perfons  in  a  fit  of  epilepfy, 
which  has  often  produced  a  fit  of  the  like  kind  in  the 
fpectator.  It  may,  indeed,  be  a  quefdon,  Whether 
this  effect  be  imputable  to  the  horror  produced  by  a 
fight  of  the  feemmgly  painful  agitations  of  the  limbs, 
and.  of  the  distortions  in  the  countenance  of  the  epi- 
leptic peifon;  or  if  it  may  be  afcribed  to  the  force  of 
imitation  merely  ?  It  is  pt>ilibie,  that  horror  may  fome- 
times  produce  the  effect  :  but  cert  -inly  much  rmy  br* 
imputed  to  that  propenlity  to  imitation,  at  alt  tirres 
fo  powerful  and  prevalent  in  human  nature  :  and  fi 
often  operating  in  other  cafes  of  convuiiivc;  difonleis, 
which  do  not  prefent  any  fpeclacle  of  horror. 
MCCXCI1I. 

Under  the  fame  head  of  Mental  Irritation,  I  think 
proper  to  mention  as  an  inftance  of  it,  the  Epilepiia 
ta,  or  the  Feigned  Epilepfy,  io  often  taken  no- 
tice 


i5S  PRACTICE 

lice  of.  Although  this,  at  the  firft,  may  be  entirely 
feigned,  I  have  no  doubt  but  that  the  repetition  ren- 
ders it  at  lenrth  ren:.  The  hiftory  of  Quietifrn  and 
of  Exorcifms  leads  me  to  this  opinion :  and  which 
receives  a  confirmation  from  what  we  know  of  the 
power  of  imagi nation,  in  renewing  epileptic  and  hyfc 
teric  fits. 

MCCXCIV. 

I  come  now  to  the  fourth   head  of  th<5  irritations 
applied  immediately  to  the  brain,  and  which  I  appre- 
hend to  be  that  of  fhe   over-dillenfion  of  the  blood- 
vcifcls  in  that  organ.     That  fuch  a  caufe  operates  in 
producing  epilepfy,   is   probable  from  this?   that  the 
difiedion  of  pcrfons  dsad  of  epilepfy,    has  commonly 
tliicovered  the  marks  of  a  previous  congeftion  in  the 
blood-veusls  of  the  brain.       This,  perhaps,  may  be 
iuppoft'd  the  effect  of  the  fit  which  proved  fatal:   but 
that  the  ccngeftion  wafc  previous  thereto,  is  probable 
from  the  epilepfy  being  fo  often  joined  with  headach, 
mania,  prJfy,  and  apoplexy  ;  all  of  them  difeafes  de- 
pending upon  a  coiigciiion  in  the  veffels  of  the  brain. 
^  general  opinion  receives  alfo  confirmation  from 
circurnitance,  that,  in  the  brain  of  perfons  dead 
of 'epilepfy,  there  have  beenoften  found  tumours  and 
Qoos;  whicli,  though  feemingly  not  fufficient   to 
produce  thofe  difeafes  which  depend  on  the  compref- 
fion  of  a  cjniiderable  portion  of  the  brain,  may,  how- 
ever, have  been  fufficient  to  comprefs  fo  many  velfels 
:;s  to  render  the  others  upon  any  oocalion  of  a  more 
than'ufual  turgefcence,  or  impulfe  of   the  blood  into 
the  veiiels  of  the  brain  more  liable  to  an  over-diften-^ 
lion. 

MCCXCV. 

Thefe  confiderations  alone  might  afford  foundation 
for  a  probable  conjecture  with  refpecl  to  the  effeds  of 
over-diiteridon.     But  the  opinion,  does  not  reft  upon 
conjecture  alone.     Th.it  it  is  alfo  founded  in  facl,  ap- 
pears 


OFF  II  Y  S  I  C.  159 

pears  from  hence,  that  a  plethoric  ftate  is  favourable 
to  epilepfy ;  and  that  every  occalional  turgefcence, 
or  unufual  impulfe  of  the  blood  into  the  veflels  of  the 
brain,  fuch  as  a  fit  of  anger,  the  heat  of  the  fun,  or  of 
a  warm  chamber,  violent  exercife,  a  furfeit,  or  a  fit  of 
intoxication,  are  frequently  the  immediate  exciting 
caufes  of  epileptic  fits. 

MGCXCVI. 

I  venture  to  remark  further,  that  a  piece  of  theory 
may  be  admitted  as  a  confirmation  of  this  dodkine'. 
As  I  have  formerly  maintained,  that  a  certain  fulnefs 
and  teniion  of  the  velfels  of  the  brain  is  neceflary  to 
the  fupport  of  its  ordinary  and  conftant  energy,  in 
the  diilributicn  of  the  nervous  power  ;  fo  it  mull  be 
fufficiently  probable,  that  an  over-diftenfion  of  thefe 
blood- veflels  may  be  a  caufe  of  violent  excitement. 

MCCXCVIL 

We  have  now  enumerated  the  feveral  remote  or  oc- 
cafional  caufes  of  epilepfy,  acting  by  excitement,  and 
ading  immediately  upon  the  brain  itfelf.  Of  the 
caufe*  a£ting  by  excitement,  but  acling  upon  other 
parts  of  the  body,  and  from  thence  communicated  to 
the  brain,  they  are  all  of  them  impreflions  producing 
an  exquifite  or  high  degree  either  of  pleafure  or  pain. 
Impredions  which  produce  neither  the  one  nor  the 
other,  have  hardly  any  fuch  effects,  unlefs  when  fuch 
impreflions  are  in  a  violent  degree  ;  and  then  their 
operation  may  be  ccnfidered  as  a  mode  of  pain.  It  is, 
however,  to  be  remarked,  that  all  ftrong  impreflions 
which  are  fudden  and  furprifing,  or,  in  other  words, 
unforefeen  and  unexpected,  have  frequently  the  effect 
of  bringing  on  epileptic  fits. 

MCCXCVIII. 

There  are  certain  impreflions  made  upon  different 
parts  of  the  body,  which  as  they  often  operate  with- 
out producing  any  fenfation,  fo  it  is  uncertain  to  what 
head  they  belong ;  but  it  is  probable  that  the  greater 

part 


160  PRACTICE 

.part  of  them  act  by  excitement,  and  therefore  fall  to 
be  mentioned  here.  The  chief  inftances  are,  The 
teething  of  infants  ;  worms;  acidity  or  other  acrimo- 
ny in  the  alimentary  canal ;  calculi  in  the  kidneys  ; 
acrid  matter  in  abfceffes  or  ulcers;  or  acrimony  dif- 
fufed  in  the  rnafs  of  blood>  as  in  the  cafe  of  fome  con- 
tagions. 

MCCXCIX. 

Phyiicians  have  found  no  duliculty  in  comprehend- 
ing how  direct  fliniulants,  of  a  certain  force,  may  ex- 
cite the  action  of  the  brain,   and   occafion  epilepfy  : 
but  they  have   hitherto  taken  little  notice  of  certain 
caufes  which  manifestly   weaken  the  energy  of  the 
brain,  and  ad,  as  1  ipeak,  by  collapfe.     Thefe,    how- 
ever, have  the  effect  of  exciting  the  aclion  of  the  brain 
in  fuch  a  manner  as  to  occalion   epilepfy.       I   might 
upon  this  fubject,  fpeak  of  the  vis  medicatrix  natura ; 
and  there  is  a  foundation  for  the  term  ;  but,  as  I  do 
not  admit  the  Stahiian  dochine  of  adminiftering  foul, 
I  make  ule  of  the  term  only  as  expreffing  a  fa£t,  and 
\vould  not  employ  it  with  the  view  of  conveyiag  an 
explanation  of  the  manner  in   which  the  powers   of 
collapfe  mechanically  produce  their  effects.     In  the 
mean  time,  however,  I  maintain,  that  there  are  certain 
powers  of  collapfe,  which  in  cifecl:  prove  ftimulants, 
and  produce  epilepfy. 

MCCC. 

That  there  are  fuch  powers,  which  may  be  termed 
Indirect  Stimulants,  I  conclude  from  hence,  that  feve- 
ral  of  the  caufes  of  epilepfy  are  fuch  as  frequently 
produce  fyncope,  which  we  fuppofe  always  to  depend 
upon  caufes  weakening  the  energy  of  the  brain,  (MC- 
LXXVI.)  Ir  may  give  fome  difficulty  to  explain,  why 
the  fame  caufe  fometimes  occafion  fyncope,  and  fome- 
times  bccaiion  the  reaction  that  appears  in  epilepfy  ; 
and  I  (hall  not  attempt  to  explain  it:  but  this,  I  think, 
dues  not  prevent  my  ftrppofing  that  the  operation  of 

thefe 


<XF    PHYSIC.  161 

thefe  caufes  is  by  collapfe.  That  there  are  fuch'caufes 
producing  epilepfy,  will,  I  think,  appear  very  clearly 
from  the  particular  examples  of  them  I  am  now  to 
mention. 

MCCCI. 

The  ftrft  to  be  mentioned,  which  I  fuppofe  to  be 
df  this  kind,  is  hemorrhagy,  whether  fpontaneous  or 
artificial.  That  the  fame  hemorrhagy  whieh  produc- 
es fyncope,  often  at  the  fame  time  produces  epilepiy, 
is  well  known ;  and  from  many  experiments  and  ob- 
fervations  it  appears,  that  hemerrhagies  occurring  to 
fuch  a  degree  as  to  prove  mortal,  feldom  do  fo  with- 
out firlt  producing  epilepfy. 

MCCCII. 

Another  caufe  acting,  I  fuppofe,  by  collapfe,  and 
therefore  fometimes  producing  fyncope,  and  fometimes 
epilepfy,  is  terror  ;  that  is,  the  fear  of  fome  great  evil 
fuddenly  prefented.  As  this  produces  at  the  fame 
time  a  fudden  and  considerable  emotion,  (MCLXXX.) 
fo  h  more  frequently  produces  epilepfy  than  fyncope. 
MCCGIIL 

A  third  caufe  acting  by  collapfe,  and  producing 
epilepfy,  is  horror  ;  or  a  ftrong  averfion  fuddenly  raid- 
ed by  a  very  difagreeable  fenfation,  and  frequently 
arifing  from  a  fympathy  with  the  pain  or  danger  of 
another  perfon.  As  horror  is  often  a  caufe  of  fyncope, 
there  can  be  no  doubt  of  its  manner  of  operating  in 
producing  epilepfy  ;  and  it  may  perhaps  be  explain- 
ed upon  this  general  principle,  That  as  defire  excites 
action  and  gives  activity,  fo  averiion  reflrains  from 
action,  that  is,  weakens  the  energy  of  the  brain;  and, 
therefore,  that  the  higher  degrees  of  averfion  may 
have  the  effects  of  producing  fyncope  or  epilepfy. 
MCCCIV. 

A  fourth  fet  of  the  caufes  of  epilepfy,  which  I  fup- 
pofe alfoto  act  by  collapfe,  are' certain  odours,  which 
occaiion  either  fyncope  or  epikpfy  ;  and,  with  refpect 

VOL.  II.  X  to 


162  PRACTICE 

to  the  former,  I  have  given  my  reafons  (MCLXXXII.) 
for  fuppofing  odours  in  that  cafe  to  act  rather  as  difa- 
greeable  than  as  fedativc.  Thefe  reafons  will,  I  think, 
alfo  apply  here ;  and  perhaps  the  whole  affair  of  odours 
might  be  coniidered  as  inftances  of  the  effect  of  hor- 
ror, and  therefore  belonging  to  the  laft  head. 

MCCCV. 

A  fifth  head  of  the  caufes  producing  epilepfy  by 
collapfe,  is  the  operation  of  many  fubftances  conii- 
dered, and  for  the  moil  part  properly  confidered,  as 
poifons.  Many  of  thefe,  before  they  prove  mortal, 
occafion  epilepfy .•  This  effect,  indeed,  may  in  fome 
cafes  be  referred  to  the  inflammatory  operation  which 
they  fometimes  difcover  in  the  ftomach,  and  other 
parts  of  the  alimentary  canal ;  but,  as  the  greater  part 
of  the  vegetable  poifons  fhow  chiefly  a  narcotic,  or 
ftrongly  fedative  power,  it  is  probably  by  this  power 
that  they  produce  epilepfy,  and  therefore  belong  to 
this  head  of  the  caufes  acting  by  collapfe. 

MCCCVI. 

Under  the  head  of  the  remote  caufes  producing 
epilepfy5  we  mud  now  mention  that  peculiar  one 
whofe  operation  is  accompanied  with  what  is  called 
the  Aura  Epikptica.  This  is  a -fenfation  of  fomething 
moving  in  fome  part  of  the  limbs  or  trunk  of  the  bo- 
dy, and  from  thence  creeping  upwards  to  the  head ; 
and  when  it  arrives  there,  the  perfon  is  immediately 
deprived  ot  fenfe,  and  falls  into  an  epileptic  fit.  This 
motion  is  defcribed  by  the  perfons  feeling  it  fome- 
times as  a  cold  vapour,  fometimes  as  a  fluid  gliding, 
and  fometimes  as  the  fenfe  of  a  fmall  infect  creeping 
along  their  body  ;  and  very  often  they  can  give  no 
diitinct  idea  of  their  fenfation,  otherwife  than  as  in 
general  of  fomething  moving  along.  This  fenfation 
might  be  fuppofed  to  arife  from  one  affection  of  the 
extremity  or  other  part  of  a  nerve  acted  upon  by  fome 
•irritating  matter  ;  and  tint  the  fenfation,  therefore, 

fot 


OF     PHYSIC.  163 

followed  the  courfe  of  iuch  a  nerve  :  but  I  have  never 
found  it  following  diftinctly  the  courfe  of  any  nerve  ; 
and  it  generally  feems  to  pafs  along  the  teguments, 
It  has  been  found  in  fome  inftances  to  arife  fro  in 
fomething  preffing-  upon  or  irritating  a  particular 
nerve,  and  that  fometimes  in  confequencc  of  contuli- 
on  or  wound :  but  inftances  of  thefe  are  more  rare  ; 
and  the  more  common  confequences  of  contuiions  and 
wounds  is  a  tetanus.  This  latter  effect  wounds  pro- 
duce, without  giving  any  fenfation  of  an  aura  or  other 
kind  of  motion  proceeding  from  the  wounded  part  to 
the  head  ;  while,  on  the  other  hand,  the  aura  produ- 
cing epilepfy  often  arifes  from  a  part  which  never 
had  been  affected  with  wound  or  contufion,  and  in 
which  part  the  nature  of  the  irritation  can  feldom  be 
difcovered. 

It  is  natural  to  imagine  that  this  aura  epileptica  is 
an  evidence  of  fome  irritation  or  direct  flimulus  acting 
in  the  part,  and  from  thence  communicated  to  the 
brain,  and  mould  therefore  have  been  mentioned  a- 
mong  the  caufes  acting  by  excitement ;  but  the  re- 
markable difference  that  occurs  in  feemingly  like 
caufes  producing  tetanus,  gives  fome  doubt  on  this 
fubject. 

MCCCVII. 

Having  now  enumerated  the  occafional  caufes  of 
epilepfy,  I  proceed  to  confider  the  predifponent.  As 
fo  many  of  the  above-mentioned  caufes  act  upon  cer- 
tain perfons,  and  not  at  all  upon  others,  there  mud  be 
fuppofed  in  thofe  perfons  a  predifpofition  to  this  dif- 
eafe  :  But  in  what  this  predifpoiitioa  confifls,  is  not 
to  be  ealily  afcertained. 

MCCCVIII. 

As  many  of  the  occafional  caufes  are  weak  imprcf- 
fions,  and  are  applied  to  moft  perfons  with  little  or  no: 
effect,  I  conclude,  that  the  perfons  affected  by  thofe 
caufes  are  more  eafily  moved  than  others  ;  and  there- 

X  2  fore 


164  PRACTICE 

fore  that,  in  this  cafe,  a  certain  mobility  gives  the 
predifpofition.  It  will,-  perhaps,  make  this  matter 
clearer,  to  mow,  in  the  firft  place,  that  there  is  a 
greater  mobility  of  conftitution  in  fome  perfons  than 
in  others. 

MGCCIX. 

This  mobility  appears  molt  clearly  in  the  flare  of 
the  mind.  If  a  perfon  is  readily  elated  by  hope,  and 
as  readily  dcpreffed  by  fear,  and  pafies  eaiily  and 
quickly  from  one  ftate  to  the  other  ;  if  he  is  eafily 
pleafed,  and  prone  to  gaiety,  and  as  eaiily  provoked 
to  anger,  and  rendered  peevifh  ;  if  liable,  from  flight 
impreffions,  to  ftrong  emotions,  but  tenacious  of  none  ; 
this  is  the  boyifh  temperament  qui  c'Mgit  ac  ponit 
iram  temere^  et  muiatur  in  horas  ;  this  is  the  variwn  et 
mutabile  fcemina  ;  and,  both  in  the  boy  and  woman, 
every  one  perceives  and  acknowledges  a  mobility  of 
mind.  But  this  is  neceflarily  connected  with  an  an- 
alogous ftate  of  the  brain ;  that  is,  with  a  mobility,  in 
refpecl  of  every  imprefiion,  and  therefore  liable  to  a 
ready  alteration  of  excitement  and  collapfe,  and  of 
both  to  a  considerable  degree. 
MCCCX. 

There  is,  therefore,  in  certain  perfons,  a  mobility 
of  conftitution,  generally  derived  from  the  ftate  of  o- 
rigintl  ftamlna,  and  more  exquiiite  at  a  certain  period 
of  life  than  at  others  ;  but  fometimes  arifingfrom,  and 
particularly  modified  by,  occurrences  in  the  courfe 
of  life. 

MCCCXI. 

This  mobility  conlifts  in  a  greater  degree  of  either 
feniibility  or  irritability.  Thefe  conditions,  indeed, 
phyficians  confider  as  fo  neccrTarily  connected,  that 
the  conftitution  with  refpect  to  them,  may  be  confider- 
ed  as  one  and  the  fame  :  but  I  am  of  opinion  that 
they  are  different ;  and  that  mobility  may  fometimes 
Depend  upon  an  increafe  of  the  one',  and  fometimes 


O  F    P  H  Y  S  I  C.  165 

on  that  of  the  other.  If  an  a&ion  excited,  is,  by  re- 
petition rendered  more  caiily  excited,  and  more  vigo- 
rouily  performed,  I  confider  this  as  anincreafe  of  irri- 
tability only.  I  go  no  farther  on  this  fubieet  here,  as 
it  was  only  neceifary  to  take  notice  of  the  cafe  juil 
now  mentioned,  for  the  purpofe  of  explaining  why 
epilepfy,  and  convullions  of  all  kinds,  by  being  repeat- 
ed, are  more  eaiily  excited,  readily  become  habitual, 
and  are  therefore  of  more  difficult  cure. 
MCGCXII. 

However  we  may  apply  the  diilinclion  of  fenfibili- 
ty  and  irritability,  it  appears  that  the  mobility,  which 
is  the  predifponent  cauie  of  epilepfy,  depends  more 
particularly  upon  debility  3  or  upon  a  plethoric  ilate 
of  the  body. 

MCCCXIII. 

What  fhare  debility,  perhaps  by  inducing  fenfibi- 

lity,  has  in  this  matter,   appears  clearly  from  hence, 

that  children,   women,  and  other  perfons  of  man  if  eft 

debility,  are  the  mod  frequent  fubjacts  of  this  difeafe. 

MCCC.XIV. 

The  effects  of  a  plethoric  ilate  in  difpofing  to  this 
difeafe  appears  from  hence,  that  plethoric  perfons  are 
frequently  the  fubjects  of  it  :  that  it  is  commonly  ex- 
cited, as  I  have  faid  above,  by  the  caufes  of  any  unu- 
i'ual  turgefcence  of  the  blood  ;  and  that  it  has  been 
frequently  cured  by  diminithing  the  plethoric  ilate  of 
the  body. 

That  a  plethoric  ftate  of  the  body  fhould  difpofa 
to  this  difeafe,  we  may  underlland  from  feveral  con- 
iiderations.  ift,  Becaufe  a  plethoric  Rate  implies, 
for  the  moft  part  a  laxity  of  the  folids,  and  therefore 
fome  debility  in  the  moving  fibres.  2tv/y,  Becaufe, 
in  a  plethoric  ftate,  the  tone  of  the  moving  fibres  de- 
pends more  upon  their  tenficn,  than  upon  their  inhe- 
rent power  :  and  as  their  tenfion  depends  upon  the 
Quantity  and  impetus  of  the  fluid  in  the  blood- vefiels, 

which 


i66  PRACTICE 

which  are  very  changeable,  and  by  many  caufes  fre- 
quently changed,  fo  thefe  frequent  changes  muft  give 
a  mobility  to  the  fyftem.  $dfy9  Becaufe  a  plethoric 
ftate  is  favourable  to  a  congestion  of  blood  in  the 
veflels  of  the  brain,  it  muft  render  thefe  more  readily 
affected  by  every  general  turgefcence  of  blood  in  the 
fyftem,  and  therefore  more  efpecially  difpofe  to  this 
difeafe. 

MCCCXV. 

There  is  another  circumftance  of  the  body  difpof- 
ing  to  epilepfy,  which  I  cannot  fo  well  account  for  : 
and  that  is,  the  Mate  of  fleep  :  but  whether  I  can  ac- 
count for  it  or  not,  it  appears,  in  fact,  that  this  ftate 
gives  the  difpofition  Ifpeak  of;  for,  in  many  perfons  li- 
able to  this  difeafe,  the  fits  happen  only  in  the  time 
of  fleep,  or  immediately  upon  theperfon's  coming  out 
of  it.  In  a  cafe  related  by  De  Haen,  it  appeared  clear- 
ly, that  the  difpofidon  to  epilepfy  depended  entirely 
upon  the  ilate  of  the  body  in  fleep*. 
MCCCXVL 

Having  thus  considered  the  whole  of  the  remote 
caufes  of  epilepfy,  I  proceed  to  treat  of  its  cure,  as  I 
have  faid  it  is  from  the  confederation  of  thofe  remote 
caufes  only  that  we  can  obtain  any  directions  for  our 
practice  in  the  difeafe  f. 

I  be- 

*  This  was  a  very  fingular  cafe.  The  chief  circum Ranees  in  it 
were,  that  the  boy  was  more  liable  to  the  paroxyfms  when  lying  and 
afleep,  than  when  fitting  up  and  awake.  This  peculiarity  was  not 
obfervedtill  the  difeufe  had  been  of  fome  ftanding,  and,  on  a  more 
minute  attention,  the  paroxyfms  were  found  to  be  more  frequent 
when  the  patient  was  in  a  peculiar  ttate  of  fleeping,  namely,  when 
he  was  drowfy,  or  when  he  fnored  in  his  fleep,  than  when  he  enjoy- 
ed an  eafy  and  quiet  fleep.  A  natural,  quiet,  and  eafy  fleep,  was 
procured  by  the  ufe  of  opium  ;  and  in  a  {hort  time,  the  difeafe  was 
perfectly  cured  ;  but  the  boy  died  afterwards  in  confcquence  of  a 
tumor  in  his  groin. 

•j*  Other  caufes  of  Epilepfy  are  enumerated  by  medical  writers, 
which  the  author,  for  the  fake  of  brevity,  left  unnoticed. 


OF    PHYSIC.  167 

I  begin  with  obfervmg,  that  as  the  difeafe  may  be 
confidered  as  fympathic  or  idiopathic,  I  muft:  treat  of 
thefe  feparately,  and  judge  it  proper  to  begin  with  the 
former. 

MCCCXVII. 

When  this  difeafe  is  truly  fympathic,  and  depend- 
ing upon  a  primary  affection  in  feme  other  part  of  the 
body,  fuch  as  acidity  or  worms  in  the  alimentary  ca- 
nal, teething,  or  other  fimilar  caufes,  it  is  obvious  that 
fuch  primary  affedions  muft  be  removed  for  the 
cure  of  the  epilepfy  ;  but  it  is  not  our  bufinds  here 
to  fay  how  thefe  primary  difeafes  are  to  be  treated. 
MCCCXVIII. 

There  is,  however,  a  peculiar-  cafe  of  fympathic 
epilepfy;  that  is,  the  cafe  accompanied  with  the  au- 
ra 

Cafes  have  occurred  in  whicn  the  epilepfy  feems  to  have  proceed- 
ed from  an  hereditary  taint. 

Quickfilver,  either  accidentally  or  intentionally  applied,  has 
been  frequently  found  to  produce  epilepfy.  Perfons  employed  in 
gilding  of  metals  are  often  feized  with  tremblings  of  the  hands,  with 
palfy  ,and  with  epilepfy,  which  can  be  attributed  to  nothing  elfe  than 
the  abforption  of  the  vapours  of  mercury  nfed  in  the  operation,  which 
is  as  follows  :  the  piece  of  metal  to  be  gilt  is  firft  well  cleaned  and  po- 
lluted ;  fome  mercury  fhaken  with  aqua  fortis  is  fpread  upon  it,  till 
the  furface  appears- all  over  as  white  as  iilycr  :  being  then  heated  and 
le-touched  in  thole  parts  that  have  efcaped  the  mixture,  an  amalga- 
ma  of  mercury  and  gold  is  laid  on  it  ;  the  heat  foftening  the  amal- 
gama, makes  it  fpread  more  uniformly  ;  and  the  intervention  of  the 
mercury  and  aqua  fortis  makes  it  adhere  more  firmly.  The  piece 
thus  covered  with  the  amalgama  is  placed  on  a  convenient  fupport, 
over  a  charcoal  fire  ;  and  examined,  from  time  to  time,  as  the  mer- 
cury evaporates,  that,  if  any  deficiencies  appear,  they  may  be  fuppli- 
ed  with  a  little  more  of  the  amalgama  before  the  operation  is  com- 
pleted. This  procefs  necefiarily  expofes  the  artift  to  the  fumes  of 
the  mercury. 

Van  Swieten  fays  that  he  has  feen  fkulls,  in  the  dipploe  of  which 
globules  of  mercury  manifeftly  appeared  j  and  he  thinks  it  probable 
that  the  mercury  may  pofiibly  be  thrown  out  into  the  cavities  of  the 
brain  itfelf,  and  produce  much  mifchief. 

Venery,  when  exceflive,  has  been  enumerated  among  the  caufes 
of  epilepfy  by  Bocrhaave,but  on  what  authority  feems  uncertain. 


i68  PRACTICE 

ra  epileptica,  as  uefcribed  in  MCCCVI,  in  which,  though 
we  can  perceive  by  the  aura  epileptica  urifing  from  a 
particular  part,  that  there  is  feme  affection  in  that 
part ;  yet,  as  in  many  fuch  cafes  we  cannot  perceive  of 
\vhat  nature  the  affedion  is,  I  can  only  offer  the  fol- 
io wing  general  directions. 

17?.  When  the  part  can  with  fafety  be  entirely  de- 
ftroyecl,  we  fhould  endeavour  to  do  fo  by  cutting  it 
out,  or  by  defhoying  it  by  the  application  of  an  actual 
or  potential  cautery. 

2*//y,  When  the  part  cannot  properly  be  deflroyed, 
that  we  fhould  endeavour  to  correct  the  morbid  affec- 
tion in  it  by  bliitcring,  or  by  eflablifhing  aniffuc  up- 
on the  part,; 

3^/X,  When  thefe  mesfures  cannot  be  executed,  or 
do  not  fucceed,  if  the  difeafe  feems  to  proceed  from 
the  extremity  of  a  particular  nerve  which  we  can  eafi- 
ly  come  at  in  its  courfe,  it  will  be  proper  to  cut  through 
that  nerve,  as  before  propofed  on  the  fubject  of  teta- 
nus. 

4tbty9  When  it  cannot  be  perceired  that  the  aura 
arifcs  from  any  precife  place  or  point,  fo  as  to  direct 
to  the  above-mentioned  operations  ;  but,  at  the  fame 
time,  we  can  perceive  its  progrcis  along  the  limb  ;  it 
frequently  happens  that  the  epilepfy  can  be  prevented 
by  a  ligature  applied  upon  the  limb,  above  the  part 
from  which  the  aura  arifes  :  and  this  is  always  proper 
to  be  done,  both  becaufe  the  preventing  a  fit  breaks 
the  habit  of  the  difeafe,  and  becaufe  the  frequent  com- 
preflion  renders  the  nerves  lefs  fit  to  propagate  the 
aura. 

MCCCX1X, 

The  cure  of  idiopathic  epilepfy,  as  I  have  faid  a- 
bove,  is  to  be  directed  by  our  knowledge  of  the  remote 
caufes.  There  are  therefore  two  general  indications 
to  be  formed  :  The  firft  is,  to  avoid  the  occailonal  cauf- 
es ;  and  the  fecond  is,  to  remove  or  correct  the  pre- 
difponent.  This 


OF      PHYSIC.  169 

This  method,  however,  is  not  always  purely  palli- 
ative ;  as  in  many  cafes  the  prcdifponent  may  be 
confidered  as  the  only  proximate  caufe,  fo  our  fecond 
indication  may  be  often  coniidered  as  properly  cura- 
tive. 

MCCCXX. 

From  the  enumeration  given  above,  it  will  be  mani- 
feft,  that  for  the  moft  part  the  occafional  caufes,  fo 
far  as  they  are  in  our  power,  need  only  to  be  known, 
in  order  to  be  avoided  ;  and  the  means  of  doing  this 
will  be  fufficiently  obvious.  I  mall  here,  therefore, 
offer  only  a  few  remarks. 

MCCCXXI. 

One  of  the  mod  frequent  of  the  occafional  caufes  is 
that  of  over-diftenfion,  (MCGCXIV.)  which,  fo  far  as  it 
depends  upon  a  plethoric  ftate  of  the  fyftem,  I  mall 
fay  hereafter  how  it  is  to  be  avoided.  But  as,  not 
only  in  the  plethoric,  but  in  every  moveable  conftitu- 
tion,  occafional  turgefcence  is  a  frequent  means  of  ex- 
citing epilepff,  the  avoiding  therefore  of  fuch  turgef- 
cence is  what  ought  to  be  mofl  conflantly  the  object 
of  attention  to  perfons  liable  to  epilepfy. 
MCCCXXII. 

Another  of  the  mofl  frequent  exciting  caufes  of  this 
difeafe  are,  all  flrong  impreflions  fuddenly  made  upon 
the  fenfes ;  for  as  fuch  impreflions,  in  moveable  confti- 
tutions,  break  in  upon  the  ufual  force,  velocity,  and 
order  of  the  motions  of  the  nervous  fyftem,  they  there- 
by readily  produce  epilepfy.  Such  impreffions,  there- 
fore, and  efpecially  thofe  which  are  fuited  to  excite 
any  emotion  or  paffion  of  the  mind,  are  to  be  mofl 
carefully  guarded  againfl  by  perfons  liable  to  epilep- 
fy. 

MCCCXXIII. 

In  many  cafes  of  epilepfy,  where  the  predifponent 
caufe  cannot  be  corrected  or  removed,  the  recurrence 
of  the  difeafe  can  only  be  prevented  by  the  flricleft  at- 

VOL.  II.  Y  tention 


170  P  R  A  C  T  I  C  E 

tention  to  avoid  the  occafional;  and  as  the  difeafe  is  of- 
ten confirmed  by  repetition  and  habit,  fo  the  avoiding 
the  frequent  recurrence  of  it  is  of  the  utmoft  import- 
ance towards  its  cure. 

Thefe  are  the  few  remarks  I  have  to  offer  with  re- 
fpecl:  to  the  occasional  caufes  ;  and  muft  now  obferve 
that,  for  the  moil  part,  the  complete,  or,  as  it  is  called, 
the  Radical  Cure,  is  only  to  be  obtained  by  removing 
or  correcting  the  predifponent  caufe. 
MCCCXXIV. 

I  have  faid  above;,   that   the  predifponent  caufe  of 
epilcpfy  is  a  certain  mobility  of  the  fenforium  ;  and 
that  this  depends  upon  a  plethoric  ftate  of  the  fyftem, 
or  upon  a  certain  flate  of  debility  in  it. 
MCGCXXV. 

How  the  plethoric  flute  of  the  fyflem  is  to  be  cor- 
rected, I  have  treated  of  fully  above  in  DCCLXXXIII. 
€t  feq.  and  I  need  not  repeat  it  here.  It  will  be  enough 
to  fay,  that  it  is  chiefly  to  be  done  by  a  proper  ma- 
nagement of  exercife  and  diet ;  and,  with  refpeci:  to 
the  latter,  it  is  particularly  to  be  obferved  here,  that 
an  abflernious  courfc  has  been  frequently  found  to  be 
the  mod  certain  means  of  curing  epilepfy. 
MCCCXXVI. 

Confidering  the  nature  of  the  matter  poured  out 
by  iffues,  thefe  may  be  fuppofcd  to  be  a  conftant 
means  of  obviating  the  plethoric  ftate  of  the  fyftem  ; 
and  it  is,  perhaps,  therefore,  that  they  have  been  fo  oft- 
en found  ufeful  in  epilepfy.  Poffibly,  alfo,  as  an  open 
iflue  may  be  a  means  of  determining  occafional  tur- 
gefcences  to  fuch  places,  and  therefore  of  diverting 
them  in  feme  raeafure  from  their  adion  on  the  brain  ; 
fo  alfo,  in  this  manner,  iiTues  may  be  ufeful  in  epi- 
lepfy. 

MCCCXXVII. 

It  might  be  fuppofed  that  blood-letting  would  be 
the  moil  effectual  means  of  correcting  the  plethoric 

ftati 


OF      PHYSIC,  171 

ftate  of  the  fyflem  ;  and  fuch  it  certainly  proves  when 
the  plethoric  fiate  has  become  coniiderable,  and  imme- 
dia  ely  threatens  morbid  effects.  It  is  therefore,  in  fuch 
circumftances,  proper  and  neceflary  :  but  as  we  have 
faid  above,  that  blood-letting  is  not  the  proper  means 
of  obviating  a  recurrence  of  the  plethoric  Rate,  and, 
on  the  contrary,  is  often  the  means  of  favouring  it ; 
fo  it  is  not  a  remedy  advifable  in  every  circumltance 
of  epiiepfy.  There  is,  however,  a  cafe  of  epilepfy  in 
which  there  is  a  periodical  or  occafiotial  recurrence 
of  the  fulnefs  and  turgefcence  of  the  fanguiferous 
fyftem,  giving  occalion  to  a  recurrence  of  the  difeafe. 
In  inch  cafes,  when  the  means  of  preventing  plethora 
have  been  neglected,  or  may  have  proved  ineffectual, 
it  is  abfolutrly  neceflliry  for  the  practitioner  to  watch 
the  returns  of  thele  tu.gefcrnces,  and  to  obviate  their 
cfFedls  by  the  only  certain  means  of  doing  it,  thai  is} 
by  a  large  blood-letting. 

MCCGXXVIIL 

The  fecond  caufe  or  mobility  which  we  have  ailigntr 
ed,  is  a  flare  of  debility.  If  this  is  owing,  as  it  fre- 
quently is,  to  original  conformation,  it  is  perhaps  not 
poiiible  to  cure  it;  but  when  it  has  beten  brought  on 
in  the  courfe  of  life,  it  poilibiy  may  admit  of  being 
mended  •  and,  in  either  cafe,  much  may  be  done  to 
obviate  and  prevent  its  effects. 

MCCCXXIX. 

The  means  of  correcting  debility,  fofar  as  it  can  be 
done,  are,  The  perfon's  being  much  in  cool  air  ;  the 
frequent  ufe  of  cold  bathing;  the  ufe  of  exercife,  ar 
dapted  to  the  ftrength  and  habits  of  the  perfon  ;  and, 
perhaps,  the  ufe  of  aftringent  and  conic  medicines. 

Thcfe  remedies  arefuited  to  ftrengthen  the  inherent 
power  of  the  folids  or  moving  fibres :  but  as  the 
ftrength  of  thefe  depends  alfo  upon  their  tention, 
fo  when  deoiiiiy  has  proceeded  from  inanition,  the 
ftrength  may  be  reflored,  by  reftoring  the  fulnefs  and 

Y  2     '  tenfioa 


PRACTICE 

tenfion  of  the  veflels  by  a  nourifhing  diet ;  and  we 
have  had  inftances  of  the  propriety  and  fuccefs  of 
fuch  a  practice. 

MCCCXXX. 

The  means  of  obviating  the  effects  of  debility,  and 
of  the  mobility  depending  upon  it^  are  the  ufe  of  to-, 
nic  and  antifpafmodic  remedies. 

The  tonics  are,  Fear,  or  fome  danger  of  terror  ;  af- 
tringents ;  certain  vegetable  and  metallic  tonics  ;  and 
cold  bathing. 

MCCCXXXI. 

That  fear,  or  fome  degree  of  terror,  may  be  of  ufe 
In  preventing  epilepfy,  we  have  a  remarkable  proof 
in  Boerhaave's  cure  of  the  epilepfy,  which  happened 
in  the  Orphan-houfc  at  Haerlem.  See  Kauu  Boer- 
haave's  treatife,  intitled  Impetum  Fociens,  §  406. 
And  we  have  met  with  feveral  other  inftances  of  the 
fame. 

As  the  operation  of  horror  is  in  many  refpe&s  an- 
alogous to  that  of  terror,  feveral  feemingly  fuperftiti- 
ous  remedies  have  been  employed  for  the  cure  of  e- 
pilepfy;  and,  if  they  have  ever  been  fuccefsful,  I 
think  it  muft  be  imputed  to  the  horror  they  had  in- 
fpircd*. 

MCCCXXXII. 

Of  the  aflringent  medicines  ufed  for  the  cure  of  e- 
pilepfy,  the  moil  celebrated  is  the  vifcus  quercinus^ 
which,  when  given  in  large  quantities,  may  pollibly 
be  ufeful ;  but  I  believe  it  was  more  efpecially  fo  in 
ancient  times,  when  it  was  an  object  of  iuperflition. 

In 

*  Drinking  a  draught  of  the  blood  of  a  gladiator  jiift  killed  ; 
drinking  a  draught  of  water  with  a  toad  at  the  bottom  of  the  jug  ; 
eating  a  piece  of  human  liver,  or  the  marrow  of  the  bones  of  the  leg 
of  a  malefactor  ;  powder  of  the  human  fkull,  or  the  mofs  that  grows 
on  it  ;  with  a  variety  of  fuch  abominable  remedies,  were  formerly 
in  great  repute  ;  and  indeed  fome  of  them  arc  flill  retained  in  feveral 
foreign  Pharmacopoeias. 


OF      PHYSIC,  173 

In  the  few  inftances  in  which  I  have  feen  it  employed, 
ic  did  not  prove  of  any  effect*. 

MCCCXXXIII. 

Among  the  vegetable  tonics,  the  bitters  are  to  be 
reckoned  ;  and  it  is  by  this  quality  that  I  fu^ofe  the 
orange-tree  leaves  to  have  been  uieful :  but  they  are 
not  always  fo. 

MCCCXXXIV. 

The  vegetable  tonic,  which  from  its  ufe  in  analogous 
cafes  is  the  moil  promiiing,  is  the  Peruvian  bark; 
this,  upon  occaiion,  has  been  ufeful,  but  has  alfo  often 
failed.  It  is  efpecially  adapted  to  thole  epilepiies. 
which  recur  at  certain  periods,  and  which  are  at  the 
fame  time  without  the  recurrence  of  any  plethoric 
Hate,  or  turgefcence  of  the  blood ;  and  in  fuch  peri- 
odical cafes,  if  the  bark  is  employed  fome  time  before 
the  expedled  recurrence,  it  may  be  ufeful ;  but.  it  niuli 
be  given  in  large  quantity,  and  as  near  to  the  time  of 
the  expected  return  as  pofiible. 

MCCCXXXV. 

The  metallic  tonics  feem  to  be  more  powerful  than 
the  vegetable,  and  a  great  variety  of  the  former  have 
been  employed. 

Even  arfenic  has  been  employed  in  the  cure  of  epi- 
lepfy  ;  and  its  ufe  in  intermittent  fevers  gives  an  analo- 
gy in  its  favour. 

Preparations  of  tin  have  been  formerly  recommend- 
ed in  the  cure  of  epilepfy,  and  in  the  cure  of  the  ana- 
logous difeafe  of  hyfteria ;  and  feveral  confideraiions 
renders  the  virtues  of  tin,  with  relpecl:  to  thefe  difeaf- 
es,  probable  :  but  I  have  had  no  experience  of  its  ufe 
in  fuch  cafes. 

A  much  fafer  metallic  tonic  is  to  be  found  in  the 
preparations  of  iron  ;  and  we  have  feen  fome  of  them 

employed 

*  The  dofe  of  it  was  from  half  a  drachm  to  a  drachm  in  po\v.. 
an  ounce  in  infufion. 


174  PRACTICE 

employed  in  the  cure  of  epilepfy,  but  have  never 
found  them  to  be  effectual.  This,  however,  I  think, 
may  be  imputed  to  their  not  having  been  always  em- 
ployed in  the  circumttances  of  the  difeale,  and  in  the 
quantities  of  the  medicine,  that  were  proper  and  ne- 
ceilary*. 

MCCCXXXVI. 

Of  the  metallic  tonics,  the  molt  celebrated  and  the 
moft  frequently  employed  is  copper,  under  various 
preparation.  What  preparation  of  it  may  be  the 
in  oft  effectual,  I  dare  not  determine  ;  but  of  late  the 
cuprum  ammoniacum  has  been  frequently  found  fuccefs- 
fulf. 

MCCCXXXVIL 

Lately  the  flowers  of  zinc  have  been  recommended 
by  a  great  authority  as  ufeful  in  all  convulflve  diibr- 
ders ;  but  in  cafes  of  epilepfy,  I  have  not  hitherto 
found  that  medicine  ufeful  J. 

MCCCXXXVIIL 

There  have  been  of  late  fome  inftances  of  the  cure 
of  epilepfy  by  the  accidental  ufe  of  mercury  ;  and  if 
the  late  accounts  of  the  cure  of  tetanus  by  this  reme- 
dy are  confirmed,  it  will  allow  us  to  .think  that  the 
fame  may  be  adapted  alfo  to  the  cure  of  certain  cafes 
cf  epilepfy. 

MCCCXXXIX. 

*  The  method  of  ufing  iron,  was  defcribed  in  a  note  on  article 

f  This  was  a  favourite  remedy  of  the  Author's.  He  fir  A;  intro- 
duced it  into  practice  in  this  country,  and  the  preparation  of  it  was 
infer  ted  in  the  Edinburgh  Pharmacopoeia. 

It  is  employed  by  beginning  with  imall  dofes  of  half  a  grain,  and 
increasing  them  gradually  to  as  much  as  the  ftomach  will  bear.  It 
is,  however,  like  all  preparations  of  copper,  a  very  dangerous  medi- 
cine, and  ought  to  be  ufed  with  caution. 

t  The  great  authority  by  which  the  flowers  of  zinc  were  recom- 
mended was  Gaubius.  It  is  as  dangerous  a  medicine  as  the  cuprum 
ammoniacum,  and  mult  be  ufed  with  the  fame  caution. 


OF    PHYSIC.  175 

MCCCXXXIX. 

With  refpect  to  the  employment  of  any  of  the  a- 
bove  mentigned  tonics  in  this  difeafe,  it  mud  be  ob- 
ferved,  that  in  all  cafes  where  the  difeafe  depends  up- 
on a  conftant  or  occafional  plethoric  ftate  of  the  fyf- 
tem,  thefe  remedies  are  likely  to  be  ineffectual ;  and 
if  fufficient  evacuations  are  not  made  at  the  fame  time, 
thefe  medicines  are  likely  to  be  very  hurtful. 
MCCCXL. 

The  other  fct  of  medicines  which  we  have  mention- 
ed as  fuited  to  obviate  the  effects  of  the  too  great  mo- 
bility of  the  fyilem,  are  the  medicines  named  antif- 
pafmodics.  Of  thefe  there  is  a  long  lift  in  the  writers 
on  the  Materia  Medica,  and  by  thefe  authors  re- 
commended for  the  cure  of  epilepfy.  The  greater 
part,  however,  of  thofe  taken  from  the  vegetable  king- 
dom, are  manifeflly  inert  and  infignirlcant*.  Even, 
the  root  of  the  wild  valerian  hardly  fupports  its  cre- 
dit. 

MCGCXLI. 

Certain  fubftances  taken  from  the  animal  kingdom 
feem  to  be  much  more  powerful :  and  of  thefe  the 
chief,  and  feemingly  the  moft  powerful,  is  mtifk  ; 
which,  employed  in  its  genuine  ft  ate,  and  in  due  quan- 
tity, has  often  been  an  effectual  remedy f. 

It 

*  This  is  certainly  true  ;  but  it  mud  be  acknowledged  that  Tome 
of  them  are  manifeftly  active  and  ufeful,  as  the  affafcetida,  fagapenum, 
and  other  foetid  gums.  Thepilulae  gummofae  of  the  Pharmacopoeia's, 
are  good  formulae  for  thefe  naufcous  medicines  ;  and  their  being1  re- 
puted inefficacious  and  infignificant  feems  to  have  arifen  from  their 
not  having  been  given  in  fufficiently  large  dofes.  They  may  be  given 
with  fafety  to  the  quantity  of  two  drachms  in  a  day  in  repeated  dofes 
of  twenty  or  thirty  grains  each  ;  and,  if  they  mould  happen  to  purge, 
this  inconvenience  may  be  prevented,  by  adding-  a  quarter  or  half 
a  grain  of  opium  to  each  dofe  of  the  pills,  or  taking  ten  drops  of 
laudanum  after  each  dofe,  as  occafion  may  require. 

f  Muflc  is  more  effectual  when  given  in  fubftance,  thnn  in  any 
preparation  that  has  been  attempted  ;  it  is  given  in  dofes  of  from  ten 


176  PRACTICE 

It  is  probable  alfo,  that  the  oleum  animale,  as  it  has 
been  named,  when  in  its  pureft  itate,  and  exhibited  at 
a  proper  time,  may  be  an  effectual  remedy*. 
JVICCCXLIL 

In  many  difeafes,  the  mod  powerful  antifpafmodic 
is  certainly  opium;  but  the  propriety  of  its  ufe  in  epi- 
lepfy  has  been  difputcd  among  phyficians.  When 
the  difeafe  depends  upon  a  plethoric  ftate  in  which 
bleeding  may  be  neceilary,  the  employment  of  opium 
is  likely  to  be  very  hurtful  :  but,  when  there  is  no 
plethoric  or  inflammatory  ftate  prefent,  and  the  difeafe 
feems  to  depend  upon  irritation  or  upon  increafed  irri- 
tability, opium  is  likely  to  prove  the  mo  ft  certain  re- 
medyf.  Whatever  effects  in  this  and  other  convul- 
live  difordsrs  have  been  attributed  to  the  hyofcyamus, 
muft  probably  be  attributed  to  its  polTeffing  a  narcotic 
power  fimilar  to  that  of  opium. 

MCCCXLIII. 

With  refpeft  to  the  ufe  of  antifpamodics,  it  is  to  be 
obferved,  that  they  are  always  moft  ufeful,  and  per- 
haps only  ufeful,  when  employed  at  a  time  when  epi- 
leptic fits  are  frequently  recurring,  or  near  to  the 

times 

to  thirty  grains,  and  frequently  repeated.     It  may  be  made  Into  a 
bolus,  as  in  the  formula  : 

&.  Mofch.  gr.  xv. 

Tere  in  mortar,  marmor.  cum 

Sacch.  alb.  9i.  et  adde 

Ccnfeft.  cardiac,  ^is. 

M.  f.  bolus. 
This  bolus  may  be  repeated  three  or  four  times  a  day. 

*  The  dofe  of  this  oil  is  from  twenty  to  thirty  drops  ;  it  is,  how- 
ever, fcldom  ufed. 

f  In  thofe  cafes,  in  which  forne  peculiar  fymptoms  indicate  the 
approach  of  the,  fit,  opium  taken  iu  a  large  dofe  has  fometimes  pre- 
vented it  altogether  ;  but  molt  commonly,  however,  fuch  a  dofe 
greatly  Icffens  its  violence.  Two  grains  of  opium  in  fubftance,  or 
fixty  or  fcventy  drops  of  laudanum,  are  large  dofe's. 


O  F    P  H  Y  S  I  C.  177 

times  of  the  acceffion  of  fits  which  recur  after  confi- 
derable  intervals. 

MCCCXLIV. 

On  the  fubject  of  the  cure  of  epiiepfy,  I  have  only 
to  add,  that  as  the  difeafe  in  many  cafe*  is  continued 
by  the  power  of  habit  only,  and  that  in  all  cafes  habit 
has  a  great  fhare  in  increafing  mobility,  and  therefore 
in  continuing  this  difeafe  ;  fo  the  breaking  in  upon 
fuch  habit,  and  changing  the  whole  habits  of  the  fyf- 
tern,  is  likely  to  be  a  powerful  remedy  in  epiiepfy. 
Accordingly,  a  confiderable  change  of  climate,  diet, 
and  other  circumftances  in  the  manner  of  life,  has 
often  proved  a  cure  of  this  difeafe*. 
MCCCXLV. 

After  treating  of  epiiepfy,  I  might  here  treat  of 
particular  convullions,  which  are  to  be  difiinguifhed 
from  epiiepfy  by  their  being  more  partial:  that  is, 
affecting  certain  parts  of  the  body  only,  and  by  their, 
hot  being  attended  with  a  lofs  of  fenfe,  nor  ending  in 
fuch  a  comatofe  ftate  as  epiiepfy  always  does. 
MCCCXLVI. 

Of  fuch  convulfive  affections  many  different  inftan- 
ces  have  been  obferved  and  recorded  by  phylicians. 
But  many  of  theie  have  been  manifeftly  fympathic  af- 

VOL.  II.  Z  fedions, 

*  After  all  that  has  been  faid  on  this  difeafe,  we  mud  acknow-. 
kdge  that  we  know  but  little  of  its  true  nature,  and  confequently  no 
certain  method  of  eure  can  be  given.  It  has  baffled  the  fkill  of  phy- 
licians from  the  earlieft  ages  of  phyfic,  and  dill  remains  to  be  one  of 
thofe  many  difeafes  which  we  cannot  certainly  cure. 
:  Some  fpecies  of  it,  indeed,  are  certainly  curable  ;  but  thefe  are 
few,  and  fuch  only  as  are  fymptomatic,  or  arife  from  peculiar  me- 
chanical irritations. 

Experience  has  moreover  fhevvn  us,  that  the  difeafe  often  esdfts 
without  any  apparent  irritation,  and  without  any  caufe  obfervable  on 
diffecliioii.  Much  room  is  therefore  left  for  future  inveiligations  on 
this  dark  fubje&  ;  and  we  muil  at  prefent  content  ourfelves  with  the 
hopesthat  time  will  unfold  >yh»t  human  ingenuity  has  not  been  capa- 
ble of  effecting. 


i7S  PRACTICE 

fections,  to  be  cured  only  by  curing  the  primary  dife 
eafe  upon  which  they  depend,  and  therefore  not  to  be 
treated  of  here  :  Or,  though  they  are  fuch  as  cannot 
be  referred  to  another  difeafe,  as  many  of  them,  how- 
ever, have  not  any  fpecific  character  with  which  they 
occur  in  different  perfons,  1  mud  therefore  leave  them 
to  be  treated  upon  the  general  principles  I  have  laid 
down  with  refpect  to  epilepfy,  or  {hall  lay  down  with 
refpect  to  the  following  convulfive  diibrder ;  which  as 
having  very  conftantly  in  different  perfons  a  peculiar 
character,  I  think  neceffary  to  treat  of  more  particu- 
larly. 


C    H    A    P.      III. 

OF  THE  CHOREA  OR  DANCE  OF  ST.  VITUS* 

MCCCXLVII. 

THIS  difeafc  affects  both  fexes,   and  almoft  only 
young  perfons.     It  generally  happens  from  the 
age  often  to  that  of  fourteen  years*.     Itcomes  on  al- 
ways before  the  age  of  puberty,  and  rarely  continues 
beyond  that  period. 

MCCCXLVI1I. 

It  is  chiefly  marked  by  convulfive  motions,  fome- 
what  varied  in  different  perfons,  but  nearly  of  one 
kind  in  all ;  affecting  the  leg  and  arm  on  the  fame 
fide,  and  generally  on  one  fide  only, 

MCCCXLIX. 

Thefe  convulfive  motions  commonly  firlt  affect  the 

leg 

*  I  have  feen  it  in  a  robuft  man  of  forty-two.  This  patient,  after 
various  inefTedtual  remedies  had  been  ufed,  was  cured  by  ftrong  elec- 
trical fhocks  directed  through  the  whole  body. 


OF    PHYSIC.  179 

leg  and  foot.  Though  the  limb  be  at  reft,  the  foot 
is  often  agitated  by  convulfive  motions,  turning  it  al- 
ternately outwards  and  inwards.  When  walking  is 
attempted,  the  affected  leg  is  feldom  lifted  as  ufuai  in 
walking,  but  is  dragged  along  as  if  the  whole  limb 
were  paralytic  ;  and  when  it  is  attempted  to  be  lifted, 
this  motion  is  unfteadily  performed,  the  limb  .becom- 
ing agitated  by  irregular  convulfive  motions. 
MCCCL. 

The  arm  of  the  fame  fide  is  generally  affected  at 
the  fame  time  ;  and,  even  when  no  voluntary  motion, 
is  attempted,  the  arm  is  frequently  agitated  with  vari- 
ous convulfive  motions.  But  efpecially  when  volun- 
tary motions  are  attempted,  thefe  are  not  properly  ex- 
ecuted, but  are  varioufly  hurried  or  interrupted  by 
convulfive  motions  in  a  direction  contrary  to  that  in- 
tended. The  mod  common  inftance  of  this  is  in  the 
perfon's  attempting  to  carry*:a  cup  of  liquor  to  his 
rnouth,  when  it  is  only  after  repeated  efforts,  interrupt- 
ed by  frequent  convulfive  retractions  and  deviati- 
ons, that  the  cup  can  be  carried  to  the  mouth. 
MCCCL  I. 

It  appears  to  me,  that  the  will  often  yields  to  thefe 
convulfive  motions,  as  to  a  propenfity,  and  thereby 
they  are  often  increafed,  while  the  perfon  affected 
feems  pleafed  with  increaiing  the  furprife  and  amufe- 
rnent  which  his  motions  occaiion  in  the  byilanders. 
MCCCLIL 

In  this  difeafe  the  mind  is  often  affected  with  fome 
degree  of  fatuity ;  and  often  {hows  the  lame  varied, 
defultory,  and  caufelefs  emotions  which  occur  in  hy- 
steria. 

MGCCLIII. 

Thefe  are  the  mo  ft  ctrmmon  circumftances  of  this 
difeafe  ;  but  at  times,  and  in  different  perfons,  it  is 
varied  by  fome  difference  in  the  convulfive  motions, 
particularly  by  thefe  affecting  the  tread  and  trunk  of 

Z  2  the 


iSo  PRACTICE 

the  body.  As  in  this  difeafc  there  feem  to  be  pro- 
penfities  to  motion,  fo  various  fits  of  leaping  and  run- 
ning occur  in  the  perfons  affected ;  and  there  have 
been  inftances  of  this  difcafe,  confiding  of  fuch  con- 
vulfive  motions,  appearing  as  an  epidemic  in  a  certain 
corner  of  the  country.  In  fuch  inftances,  perfons  of 
different  ages  are  affected,  and  may  feem  to  make  an 
exception  to  the  general  rule  above  laid1  down ;  but 
Hill  the  perfons  are,  for  the  moil  part,  the  young  of 
both  fexes,  and  of  the  more  manifestly  moveable  con- 
Hitutions. 

MCCCLIV. 

The  method  of  curing  this  difcafe  has  been  variouf- 
ly  propofed.  Dr.  Sydenham  propofed  to  cure  it  by- 
alternate  bleeding  and  purging.  In  fome  plethoric 
habits  I  have  found  fome  bleeding  ufeful ;  but  in  ma- 
ny cafes  I  have  found  repeated  evacuations,  eipecially 
by  bleeding,  very  hurtful. 

In  many  cafes,  1  have  found  the  difeafe,  in  fpite  of 
remedies  of  all  kinds,  continue  for  many  months ;  but 
I  have  alfo  found  it  readily  yield  to  tonic  remedies,  fuch 
<is  the  Peruvian  bark,  and  chalybeates. 

The  late  Dr,  De  Haen  found  feveral  perfons  labour- 
ing under  this  difeafe  cured  by  the  application  of  elec- 
tricity. 


SECT. 


OF    P  H  Y.S  I  a  18* 

SECT.       II. 

OF  THE  SPASMODIC  AFFECTIONS  OF  THE 
VITAL  FUNCTIONS. 

CHAP.         IV  \. 

OF  THE  PALPITATION  OF  THE  HEART. 
MCCCLV. 

THE  motion  thus  named  is  a  contraction  or  fyf- 
tole  of  the  heart,  that  is  performed  with  more 
rapidity,  and  generally  alfo  with  more  force  than  ufu- 
al ;  and  when  at  the  fame  time  the  heart  ilrikcs  with 
more  than  ufual  violence  agatnft  the  infide  of  the  ribs, 
producing  often  a  coniiderable  found. 

MCCCLVI. 

This  motion  or  palpitation,  is  cccafioned  by  a  great 
variety  of  caufes,  which  have  been  recited  with  great 
pains  by  Mr.  Scnac  and  others  ;  whom  however,  I 
cannot  follow  in  all  the  particulars  with  fufficient  dif- 
cernment,  and  therefore  fhall  here  only  attempt  to  re- 
fer all  the  feveral  cafes  of  this  difeafe  to  a  few  general 
heads. 

MCCCLVII. 

The  fir  ft  is  of  thofe  arifing  from  the  application  of  the 
ufual  flimulus  to  the  heart's  contraction  ;  that  is,  the 
influx  of  the  venous  blood  into  its  cavities,  being  made 
with  more  velocity,  and  therefore,  in  the  fame  time, 
in  greater  quantity  than  ufual.  It  feems  to  be  in  this 
manner  that  violent  exercife  occafions  palpitation. 

MCCCLVIII. 

A  fecond  head  of  the  cafes  of  palpitation,  is  of  thofe 
arifing  from  any  refiftance  given  to  the  free  and  entire 
evacuation  of  the  ventricles  of  the  heart.     Thus  a  li- 
gature 

f  Though  I  have  thought  it  proper  to  divide  this  book  into  fec- 
tions,  I  think  it  ncceflary,  for  the  convenience  of  references,  to  num- 
ber the  chapteri  from  the  beginning. 


183  PRACTICE 

gaturc  made  upon  the  aorta  occafions  palpitations  of 
the  moll  violent  kind.  Similar  refinances,  either  in 
the  aorta  or  pulmonary  artery,  may  be  readily  imagin- 
ed ;  and  fuch  have  been  often  found  in  dead  bodies  of 
peiicms  who,  during  life,  had  been  much  affected  with 
palpitations. 

To  this  head  are  to  be  referred  all  thofe  cafes  of 
palpitation  arifing  from  caufes  producing  an  accumu- 
lation of  blood  in  the  great  veffels  near  to  the  heart. 
MCCCLIX. 

A  third  head  of  the  cafes  of  palpitation,  is  of  thofe 
arifing  from  a  more  violent  and  rapid  influx  of  the  ner- 
vous power  into  the  mufcular  fibres  of  the  heart.  It 
is  in  this  manner  that  I  fuppofe  various  caufes  acting 
in  the  brain,  and  particularly  certain  emotions  of  the 
rnind,  cccafion  palpitation. 

MCCCLX. 

A  fourth  head  of  the  cafes  of  palpitation,  is  of  thofe 
arifing  from  caufes  producing  a  weakneis  in  the  acli- 
on  of  the  heart,  by  diminiihing  the  energy  of  the 
brain  with  refpect  to  it  That  fuch  cafes  operate  in 
producing  palpitation,  1  prefume  from  hence,  that  all 
the  feveral  caufes  mentioned  above  (MCLXXVII.  €t  feq.) 
as  in  this  manner  producing  fyncope,  do  often  pro- 
duce palpitation.  It  is  on  this  ground  that  thefe  two 
difeafcs  are  affections  frequently  occurring  in  the  fame 
perfon,  as  the  fame  caufes  may  occafion  the  one  or  the 
other,  according  to  the  force  of  the  caufe  and  mobili- 
ty of  the  perfon  afted  upon.  It  feems  to  be  a  law  of 
human  ceconomy,  that  a  degree  of  debility  occurring 
in  any  function,  often  produces  a  more  vigorous  exer- 
tion of  the  fame,  or  at  leaft  an  effort  towards  it,  and 
that  commonly  in  a  convulfive  mar.ner. 

I  apprehend  it  to  be  the  convulfive  aclion,  frequent- 
ly ending  in  ibme  degree  of  a  fpafm,  that  gives  ccca- 
fion to  the  intermittent  pulfe  fo  frequently  accompa- 
nying palpitation. 

MCCCLXI. 


OF  PHYSIC.  184 

MCCCLXL 

A  fifth  head  of  the  caufes  of  palpitation  may  per- 
haps be  of  thole  ariling  from  a  peculiar  irritability  or 
mobility  of  the  heart.  This,  indeed,  may  be  confi- 
dered  as  a  predifponent  caufe  only,  giving  occaiion  to 
the  a£tion  of  the  greater  part  of  the  •  caufes  recited  a- 
bove.  But  it  is  proper  to  obferve,  this  predifpoiltiori 
is  often  the  chief  part  of  the  remote  caufe  ;  inibmuch 
that  many  of  the  caufes  producing  palpitation  would 
not  have  this  effect  but  in  perfons  peculiarly  predif- 
pofed.  This  head,  therefore,  of  the  cafes  of  palpita- 
tion, often  requires  to  be  diftinguidied  from  all  the 
reft. 

MGCCLXII. 

After  thus  marking  the  feveral  cafes  and  caufes  of 
palpitation,  I  think  it  neceilary,  with  a  view  to  the 
cure  of  this  difeafe,  to  obfervc,  that  the  feveral  caufes 
of  it  may  be  ag:-im  reduced  to  two  heads.  The  firft 
is,  of  thofe  confiding  in,  or  depending  upon,  certain 
organic  affe&ions  of  the  heart  itfelf,  or  of  the  great 
veiFcls  immediately  connected  with  it.  The  fecond 
is,  of  thofe  confiHing  in,  or  depending  upon,  certain 
affections  fubfiiting  and  acting  in  other  parts  of  the 
body,  and  acting  either  by  the  force  of  the  caufe,  or 
in  confequenee  of  the  mobility  of  the  heart. 
MCCCLXIIL 

With  refpect  to  the  cafes  depending  upon  the  firil 
fet  of  caufes,  I  muft  repeat  here  whatjrl  find  with  re- 
fpect to  the  like  cafes  of  fyncope,  that  I  do  not  know 
any  means  of  curing  them.  They,  indeed,  admit  of 
fome  palliation,  firft >  by  avoiding  every  circuniftance 
that  may  hurry  the  circulation  of  the  blood  ;  and,  fe- 
condly,  by  every  means  of  avoiding  a  plethoric  ftate 
of  the  fyftem,  or  any  occaflonal  turgefcence  of  the 
blood.  In  many  of  thefe  cafes,  blood-letting  nuy  give 
a  temporary  relief:  but  in  fo  far  as  debilkv  und  mobi- 

lity 


i8j  PRACTICE 

lity  are  concerned,  in  fiich  cafes  this  remedy  is  likely 
to  do  harm. 

MCCCLXIV. 

With  refpect  to  the  cafes  depending  upon  the 
other  fet  of  caufes,  they  may  be  various,  and  require 
very  different  meafures  :  J3iit  I  can  here  fay  in  gene-^ 
nil,  that  thefe  cafes  may  be  coniidered  as  of  two 
kinds  ;  one  depending  upon  primary  affections  in  o^ 
ther  parts  of  the  body,  and  a6ting  by  the  force  of  the 
particular  caufes ;  and  another  depending  upon  a 
ihite  of  mobility  in  the  heart  itfelf.  In  the  fir  ft  of 
thefe,  it  is  obvious,  that  the  cure  of  the  palpitation  muft 
be  obtained  by  curing  the  primary  affection  :  which 
is  not  to  be  treated  of  here.  In  the  fecond,  the  cure 
mull  be  obtained,  partly  by  diligently  avoiding  the  oc- 
caiional  caufes,  partly  and  chiefly  by  correcting  the 
mobility  of  the  fyitem,  and  of  the  heart  in  particular  ; 
for  doing  which  we  have  treated  of  the  proper  means 
clfewhere. 


CHAP.        V. 

OF  DYSPNOEA,    OR  DIFFICULT  BREATH- 
ING. 

MCCCLXV. 

THE  exercife  of  refpiration,  and  the  organs  of  it, 
have  fo  conftant  and  confidcrable  a  conncclion 
with  almoft  the  whole  of  the  other  functions  and  parts 
of  the  human  body,  that  upon  almoft  every  occafion 
of  difeafe,  refpiration  muft  be  affe&ed.  Accordingly 
fome  difficulty  and  diforder  in  this  function,  are  in 
fact  fymptoms  very  generally  accompanying  difeafe. 

MCCCLXVI. 


OF    PHYSIC,  185 

MCCCLXVI. 

Upon  this  account,  the  fymptom  of  difficult  breath- 
ing deferves  a  chief  place  :  nd  an  ample  confideration 
in  the  general  fyftem  of  Pathology ;  but  what  mare 
of  eonfideration  it  ought  to  have  in  a  tteatife  of  Prac- 
tice, I  find  it  "difficult  to  determine. 
MCCCLXVIL 

On  this  fubjecl,  it  is,  in  the  firft  place,  neceiTary  to 
diftinguifli  between  the  fymptomatic  and  idiopathic 
affections :  that  is,  between  thofe  difficulties  of  breath- 
ing which  are  fymptoms  only  of  a  more  general  af- 
fection, or  of  a  difeafe  fubfilling  primarily  in  other 
parts  than  the  organs  of  refpiration,  and  that  difficul- 
ty of  breathing  which  depends  upon  a  primary  affec- 
tion of  the  lungs  themfelves.  The  various  cafes  of 
fymptomatic  dyfpncea  I  have  taken  pains  to  enume- 
rate in  my  Methodical  Noiblogy,  and  it  will  be  obvi- 
ous they  are  fuch  as  cannot  be  takeri  notice  of  here. 
MCCCLXVI1L 

In  my  Nofology  I  have  alfo  takeri  pains  to  point 
out  and  enumerate  the  proper,  or  at  lead  the  greater 
part  of  the  proper,  idiopathic  cafes  of  dyfpncea;  but 
from  that  enumeration  it  will,  I  think,  readily  ap- 
pear, that  few,  and  indeed  hardly  any,  of  thefe  cafes 
will  admit  or  require  much  of  our  notice  in  this  place, 
MCCCLX1X. 

The  Dyfpncea  Sicca*,fpecies  id,  the  Dyfpncea  Ae- 
rea\,fp.  $d,  the  Dyfpncea  Terrea\^fp.  4^,  and  Dyf- 

VOL.  II.  A  a  pncea 

* -The  definition,  which  the  author  gives  of  this  {pecks  in  Li*  No- 
fology is  Dyfpncea  cum  tuffi  pleriimque  iicca  It  aiiies  from  vari- 
ous canfes,  fome  of  which  arc  extremely  difficult,  if  not  impofiiblc,  to 
be  difcovered. 

§  The  definition  of  this  fpecies  is,  Dyfpnoea  a  minima  quuvis 
fempeftatum  mutatione  auda. 

^  It  is  defined  Dyfpnoea  cum  tuffi  materiam  tcrream  vel  caleulo- 
fam  ejiciente.  This  is  fometimcs  the  expulfion  of  a  gouty  matter*. 


1 86  PRACTICE 

pncea  noracica*,Jp.  jtb,  are  fomc  of  them  with  diffi- 
culty known,  and  are  all  of  them  difeafes  which  in 
my  opinion  do  not  admit  of  cure.  All,  therefore, 
that  can  be  faid  concerning  them  here  is,  that  they 
may  admit  of  fome  palliation  ;  and  this,  I  think,  is  to 
be  obtained  chiefly  by  avoiding  the  plethoric  (late  of 
the  lungs §,  and  every  circumftance  that  may  hurry 
refpiration. 

MCCCLXX. 

Of  the  Dyfpncea  Extrlnfecaj^  fp.  8/£,  I  can  fay  no 
more,  but  that  thefe  external  caufes  marked  in  the 
Nofology,  and  perhaps  fome  others  that  might  have 
like  effeds,  are  to  be  carefully  avoided  ;  or,  when  they 
have  been  applied,  and  their  effects  have  taken  place,  the 
difeafe  is  to  be  palliated  by  the  means  mentioned  in 
the  laft  paragraph. 

MCCCLXXI. 

The  other  fpecies,  though  enumerated  as  idiopathic, 
can  hardly  be  confidered  as  fuch,  or  as  requiring  to 
be  treated  of  here. 

The  Dyfpncea  Catarrhalis\^fp.  ift,  may  be  conli- 
dered  as  a  fpecies  of  catarrh,  and  is  pretty  certainly 
to  be  cured  by  the  fame  remedies  as  that  fpecies  of  ca- 
tarrh which  depends  rather  upon  the  increafed  afflux 
of  mucus  to  the  bronchise,  than  upon  any  inflammato- 
ry Hate  of  them||. 

The 

*  The  definition  of  this  fpecies  is,  Dyfpnoea  a  partibusthoracem 
cingentibus'laefis,  vcl  male  conformatis. 

§  This  intention  is  moil  fpeedily  obtained  by  occafional  bleeding. 

f  It  is  defined  Dyfpnoea  a  caufis'externis  manifeilis.  Thefe  cauf- 
es are  various,  as  expofure  to  duft  of  different  kinds,  to  metallic  fumes, 
to  vitiated  air,  to  vapours  of  different  kinds,  &c. 

J  It  is  defined,  Dyfpnoea  cum  tufli  frtquente  mucum  vifcidein 
copiofum  ejiciente. 

j|  The  remedies  for  this  purpofe  are,  emetics,  fudorifics,  and  ex- 
pectorants j  formulae  of  which  rxiay  be  fccn  in  the  notes  on  article 
1006, 


O  F    P  H  T  S  I  C.  187 

The  Dyfpnoea  Aquofa*,  fp.  $tby  is  certainly  to  be 
eonfidered  as  a  fpecies  of  dropfy,  and  is  to  be  treated 
by  the  fame  remedies  as  the  other  fpecies  of  that  dif- 
eafe. 

The  Dyfpnoea  Pinguedinofa-\,  fp.   6th>  is   in  like 
manner  to  be  conlidered  as  a  fymptom  or  local  effect 
of  the  Polyfarcia,  and  is  only  to  be  cured  by  correct- 
ing the  general  fault  of  the  fyftem^:. 
MCCCLXXII. 

From  this  view  of  thofe  idiopathic  cafes  of  dyf- 
pnoea,  which  are  perhaps  all  I  could  properly  arrange 
under  this  title,  it  will  readily  appear  that  there  is  lit- 
tle room  for  treating  of  them  here :  but  there  is  flill 
one  cafe  of  difficult  breathing,  which  has  been  proper- 
ly diftinguLTied  from  every  other  under  the  title  of 
Afthma  ;  and  as  it  deferves  our  particular  attention,  I 
lhall  here  feparately  confider  it. 


CHAP,       VI. 


OF       ASTHMA. 

MCCCLXXIIL 

THE  term  of  Afthma  has  been  commonly  applied 
by  the  vulgar,  and  even  by  many  writers  on  the 
Practice  of  Phyfic,  to  every  cafe  of  difficult  breathing, 

A    a   2  that 

*  It  is  defined,  Dyfpnoea  cum  urina  parca,  et  ocdemate,  pedum, 
fine  flu6tuatione  in  pedlore,  vcl  aliis  chara<5terifticis  hydrothoracis- 
fignis. 

•j-  It  is  defined,  Dyfpnoea  in  hominibus  valde  obefis. 

t  A  low  diet,  fufficient  exercifc,  fweating,  and  brifl^  purges,  will 
foou  have  the  defired  effeft  ;  and  the  difeafe  may  be  prevented  by 
abikmious  living. 


i88  PRACTICE 

that  is,  to  every  fpecies  of  Dyfpnoea,     The  Methodi- 
cal Nofologifts,  alfo,  have  diftinguifhed  Afthma  from 
Dyfpncea  chiefly,  and  almoft  folely,  by  the  former  be- 
ing the  fame  affection  with  the  latter,  but  in  a  higher 
degree.     Neither  of  thefe   applications  of  the   term 
fecms  to  have  been  correft  or  proper,     I  am  of  opini- 
on, that  the  term  Afthma  may  be  mod  properly  ap- 
plied,  and  fhould  be  confined,   to  a  cafe  of  difficult 
breathing  that  has  peculiar  fymptoms,    and  depends 
upon  a  peculiar  proximate  caufe,   which  I  hope  to  af- 
lign  withfufficient  certainty.    It  is  thisdifeafc  I  am  now 
to  treat  of,  and  it  is  nearly  what  Practical  Writers  have 
generally  diftinguifhed  from  the  other  cafes  of  diffi- 
cult breathing,  by  the  title  of  Spafmodic  Afthma,  or 
of  AJtbma  convuljivum  ;   altho*  by  not  diftinguiihing 
it  with  fufficient  accuracy  from  the  other  cafes  of  Dyi  - 
pncea,  they  have  introduced  a  great  deal  of  confuiiou 
into  their  treatifes  on  this  fubjecl. 

DCCCLXX1V. 

The  difeafe  I  am  to  treat  of,  or  the  Afthma  to  be 
ftrictly  fo  called,  is  often  a  hereditary  difeafe.  It* 
feldom  appears  very  early  in  life,  and  -hardly  till  the 
time  of  puberty,  or  after  it.  It  affects  both  fexes,  but 
moft  frequently  the  male.  I  have  not  obferved  it  to 
be  more  frequent  in  one  kind  of  temperament  than 
in  another ;  and  it  does  not  feem  to  depend  upon  any 
general  temperament  of  the  whole  body,  but  upon  a 
particular  conftitution  of  the  lungs  alone.  It  frequent- 
ly attacks  perfons  of  a  full  habit ;  but  it  hardly  ever 
continues  to  be  repeated  for  fome  length  of  time  with- 
out occasioning  an  emaciation  of  the  whole  body. 

MCCCLXXV. 

The  attacks  of  this  difeafe  are  generally  in  the 
night-time,  or  towards  the  approach  of  night ;  but 
there  arc  alfo  fome  inftances  of  their  coming  on  in 

the 

*  This  defcription  of  the  difeafe  under  confideration  is  excellent. 


OF    PHYSIC.  189 

ithe  courfe  of  the  day.  At  whatever  time  they  come 
on,  it  is  for  the  moft  part  fuddenly,  with  a  fen(e  of 
tightnefs  and  ftriclure  acrofs  the  breaft,  and  a  fenfe  of 
flraitnefs  in  the  lungs  impeding  inspiration.  The  per- 
fonthus  attacked,  if  in  a  horizontal  iituation,  is  imme- 
diately obliged  to  get  into  fomewhat  of  an  creel:  pof- 
ture,  and  requires  a  free  and  cool  air.  The  difficulty 
of  breathing  goes  on  for  fome  time  increafing ;  and 
both  infpiration  and  exfpiration  are  performed  ilowly? 
arid  with  a  wheezing  noife.  In  violent  fits,  fpeaking 
is  difficult  and  uneafy.  There  is  often  fome  propen- 
fity  to  coughing,  but  it  can  hardly  be  executed. 

MCGCLXXVL 

Thefe  fymptoms  often  continue  for  many  hours  to- 
gether, and  particularly  from  midnight  till  the  morn- 
ing is  far  advanced.  •  Then  commonly  a  remiffion 
takes  place  by  degrees  ;  the  breathing  becomes  lefs  la- 
borious and  more  full,  fo  that  the  perfon  can  fpeak  and 
cough  with  more  eafe  ;  and,  if  the  cough  brings  up 
fome  mucus,  the  remiffion  becomes  immediately  more 
confiderable,  and  the  perfon  falls  into  a  much  wilhed- 
for  flee  p. 

MCGCLXXVII. 

During  thefe  fits  the  pulfe  often  continues  in  its  na- 
tural (late ;  but  in  fome  perfons  the  fits  are  attended 
with  a  frequency  of  pulfe,  and  with  fome  heat  and 
third,  as  marks  of  fome  degree  of  fever.  If  urine  be 
yoided  at  the  beginning  of  a  fit,  it  is  commonly  in 
considerable  quantity,  and  with  little  colour  or  odour; 
but,  after  the  fit  is  over,  the  urine  voided  is  in  the  or- 
dinary quantity  of  a  high  colour,  and  fometimcs  depo- 
fites  a  fediment.  In  ibme  perfons,  during  the  fit,  the 
face  is  a  little  fluflied  and  turgid  ;  but  more  common- 
ly it  is  fomewhat  pa!e  and  fhrunk. 

MCCCLXXVIII. 

After  fome  fleep  in  the  morning,   the  patient,  for 
$he  reft  of  the  day,  continues  to  have  more  free  and 

eafy 


190  PRACTICE 

eafy  breathing,  but  it  is  feldom  entirely  fuch.  He 
ftill  feels  fome  tightnefs  acrofs  his  breaft,  cannot 
breathe  eafily  in  a  horizontal  pofture,  and  can  hardly 
bear  any  motion  of  his  body,  without  having  his 
breathing  rendered  more  difficult  and  uneafy.  In  the 
afternoon  he  has  an  unufual  flatulency  of  his  fiomach, 
and  an  unufual  drowfinefs  ;  and,  very  frequently,  thefe 
fymptoms  precede  the  firft  attacks  of  the  difeafe. 
Put,  whether  thefe  fymptoms  appear  or  not,  the  diffi- 
culty of  breathing  returns  towards  the  -evening  ;  and 
then  fomelimes  gradually  increafes,  till  it  becomes  as 
violent  as  in  the  night  before :  or  if,  during  the  day, 
the  difficulty  of  breathing  has  been  moderate,  and 
the  perfon  got  fome  ileep  in  the  firft  part  of  the  night, 
he  is,  however,  waked  about  midnight,  or  at  fome 
time  between  midnight  and  two  o'clock  in  the  morn- 
ing ;  and  is  then  fuddenly  feized  with  a  fit  of  difficult 
breathing,  which  runs  the  fame  courfe  as  the  night 
before, 

MCCCLXXIX. 

In  this  manner  fits  return  for  feveral  nights  fuccef- 
fively  :  but  generally,  after  fame  nights  palled  in  this 
way,  the  fits  fuifer  more  confiderable  remiffions.  This 
efpccidlly  happens  when  the  remiffions  are  attended 
with  a  more  copious  expectoration  in  the  mornings, 
and  that  this  tontinues  from  time  to  time  throughout 
the  day.  In  thefe  circumflances,  afthmatics,  for  a 
long  time  after,  have  not  only  more  eafy  days,  but  en- 
joy alfo  nights  of  entire  fleep,  without  the  recurrence 
of  the  difeafe. 

MCCCLXXX. 

When  this  difeafe,  however,  has  once  taken  place  in 
the  manner  above  defcribed,  it  is  ready  to  return  at 
times  for  the  whole  of  life  after.  Thefe  returns, 
however,  happen  with  different  circumftances  in  dif- 
ferent perfons. 

MCCCLXXXI. 


O  F    P  H  Y  S  I  C.  19* 

MCCCLXXXI. 

In  fome  perfons  the  fits  are  readily  excited  by  exter- 
nal heat,  whether  of  the  weather  or  of  a  warm  cham* 
her,  and  particularly  by  warm  bathing.  In  fuch  per- 
fons fits  are  more  frequent  in  fummer,  and  particular- 
ly during  the  dog-days,  than  at  other  colder  feafons. 
The  fame  perfons  are  alfo  readily  affected  by  changes 
of  the  weather ;  efpecially  by  fudden  changes  made 
from  a  colder  to  a  warmer,  or,  what  is  commonly  the 
fame  thing,  from  a  heavier  to  a  lighter  atmofphere. 
The  fame  perfons  are  alfo  affected  by  every  circum- 
ftance  threatening  the  capacity  of  the  thorax,  as  by 
any  ligature  made,  or  even  by  a  plafter  laid,  upon  it  ^ 
and  a  like  effect  happens  from  any  increafed  bulk  of 
the  ftomach,  either  by  a  full  meal,  or  by  air  collected 
in  it.  They  are  likewife  much  affected  by  exercife,  or 
whatever  elfe  can  hurry  the  circulation  of  the  blood. 
MCCCLXXXII. 

As  afthmatic  fits  feem  thus  to  depend  upon  fome 
fulnefs  of  the  veflels  of  the  lungs,  it  is  probable  that 
an  obrlruction  of  perfpiration,  and  the  blood  being 
lefs  determined  to  the  furface  of  the  body,  may  fa- 
vour an  accumulation  in  the  lungs,  and  thereby  be  a 
means  of  exciting  afthma.  This  feems  to  be  the  cafe 
of  thofe  afthmatics  who  have  fits  mod  frequently  in 
the  winter-feafon,  a|id  who  have  commonly  more  of  a 
catarrhal  affection  4ccompanying  the  afthma ;  which 
therefore  occurs  more  frequently  in  winter,  and  more 
manifeftly  from  the  application  of  cold. 
MCCCLXXXIIL 

Befide  thefe  cafes  of  ailhma  excited  by  heat  or  cold, 
there  are  others,  in  which  the  fits  are  efpecially  excit- 
ed by  powers  applied  to  the  nervous  fyfiem ;  as  by 
pafTions  of  the  mind,  by  particular  odours,  and  by  ir- 
ritations of  fmoke  and  dud. 

That  this  difeafe  is  an  affection  of  the  nervous  fyf- 
tem,  and  depending  upon  a  mobility  of  the  moving  fi- 


292  PRACTICE 

bres  of  the  lungs,  appears  pretty  clearly  from  its  be- 
ing frequently  attended  with  other  fpafmodic  affecli- 
ons  depending  upon  mobility ;  fuch  as  hyileriaj  hy- 
pochondriafis,  dyfpepfia,  and  atonic  gout. 

MCCCLXXXIV.  ' 

From  the  whole  of  the  hiitory  of  afthma  now  deliver- 
ed, 1  think  it  will  readily  appear,  that  the  proximate 
caufe  of  this  difeafe  is  a  preternatural,  and  in  fome 
ineafure  a  fpafmodic,  conftridion  of  the  mufcular  fibres 
of  the  bronchia  ;  which  not  only  prevents  the  dilata- 
tion of  the  bronchiae  neceflary  to  a  free  and  full  in- 
fpiration,  but  gives  alfo  a  rigidity  which  prevents  a 
full  and  free  expiration.  This  preternatural  conftric- 
tion,  like  many  other  convulfive  and  fpafmodic  af- 
fections, is  readily  excited  by  a  turgefcenceof  the  blood, 
or  other  caufe  of  any  unufual  fulnefs  and  diftentioii 
of  the  veflcls  of  the  lungs. 

MCCCLXXXV. 

This  difeafe,  as  coming  by  fits,  may  be  generally 
diflinguifhed  from  moft  other  fpedcjs  of  dyfpncea,  whole 
caufes  being  more  conftantly  applied,  produce  there- 
fore a  more  conftant  difficulty  of  breathing.  There 
may,  however,  be  fome  fallacy  in  this  matter,  as  fome 
of  thefe  caufes  may  be  liable  to  have  abatements  and 
intenfities,  whereby  the  dyfpnoea  produced  by  them, 
may  fcem  to  come  by  fits ;  but  I  believe  it  is  feldom 
that  fuch  fits  put  on  the  appearance  of  the  genuine 
afthmatic  fits  defcribed  above.  Perhaps,  however, 
there  is  ftill  another  cafe  that  may  give  more  difficulty ; 
and  that  is,  when  fcveral  of  the  caufes,  which  we  have 
affigned  as  caufes  of  feveral  of  the  fpccies  of  difficult 
breathing  referred  to  the  genius  of  Dyfpnoea,  may  have 
t^e  effect  of  exciting  a  genuine  afthmatic  fit.  Whe- 
ther this  can  happen  to  any  but  the  peculiarly  preciif- 
pofed  to  afthma,  I  am  uncertain ;  and  therefore,  whe- 
ther, in  any  fuch  cafes,  the  afthma  may  be  coniider- 
ed  as  fymptomatic  3  or  if,  in  all  iuch  cafes,  the  afthma 

may 


O  F    P  H  Y  S  I  C.  193 

rr.ay  not  ftill  be  conlidered  an3.  treated  as  an  icllopa- 
thic  difeafe. 

MCCCLXXXVI. 

The  afthma,  though  often  threatening  immediate 
death,  feldom  occafions  it;  and  many  petfons  have 
lived  long  under  this  difeafe.  In  many  cafes,  however, 
it  does  prove  fatal  ;  fometimes  very  quickly,  and  per- 
haps always  at  length.  In  fome  young  perfons  it  has 
ended  foon,  by  occaiioning  a  phthifis  palnionalis.  Af- 
ter a  long  continuance,  it  often  ends  in  a  hydrothorax ; 
and  commonly,  by  occafioning  fome  aneurifm  of  the 
heart  or  great  verTels,  it  thereby  proves  fatal. 
MCCCLXXXVII. 

As  it  is  feldom  that  an  afthrna  has  been  entirely  cur- 
ed; I  therefore  cannot  propofe  any  method  of  cure 
which  experience  has  approved  as  generally  fuccefsful. 
But  the  difeafe  admits  of  alleviation  in  feveral  refpeds 
from  the  life  of  remedies ;  and  my  bulinefs  now  fhall 
be  chiefly  to  offer  fome  remarks  upon  the  choice  and 
ufe  of  the  remedies  which  have  been  commonly  em- 
ployed in  cafes  of  afthma. 

MCCCLXXXVIII. 

As  the  danger  of  an  aft h made  fit  arifes  chiefly  from, 
the  difficult  tranfmiffion  of  the  blood  through  the  vcf- 
fels  of  the  lungs,  threatening  fuffocation ;  fo  the  mod 
probable  means  of  obviating  this  feems  to  be  blood- 
letting :  and  therefore,  in  all  violent  fits,  practitioners 
have  had  recourfe  to  this  remedy.  -In  firit  attacks, 
and  efpecially  in  young  and  plethoric  perfons,  blood- 
letting maybe  very  necefTary,  and  is  commonly  ail- 
able.  But  it  is  alfo  evident,  that,  under  the  frequent 
recurrence  of  fits,  blood-letting  cannot  be  frequently 
repeated  without  exhaufting  and  weakening  the  pati- 
ent too  much.  It  is  further  to  be  obferved,  that  blood* 
letting  is  not  fo  neceffary  as  might  be  imagined,  as 
the  pailage  of  the  blood  through  the  lungs  is  not  fo 

Voi.  II.  B   b  much 


PRACTICE 

interrupted  as  has  been  commonly  fuppofed.  This  I 
particularly  conclude  from  hence,  that,  inftead  ok  the 
fufftifion  efface,  which  is  the  ufuaLeffe&of  fuch  inter- 
ruption, the  face,  in  afthmatics  fits,  is  often  fhrunk 
and  pale.  I  conclude  the  fame  alfo  from  this,  that, 
in  afthmatic  fits,  blood-letting  does  not  commonly 
give  fo  much  relief  as,  upon  trie  contrary  fuppofition, 
might  be  expected. 

MCCCLXXXIX. 

As  I  have  alledged  above,  that  a  turgefcence  of  the 
blood  is  frequently  the  exciting  caufe  of  afthmatic  fits, 
fo  it  might  be  fuppofed,  that  a  plethoric  ftate  of  the 
fyftem  might  have  a  great  fhare  in  producing  a  tur- 
gefcence of  the  blood  in  the  lungs  ;  and  efpecially, 
therefore,  that  blood-letting  might  be  a  proper  reme- 
dy in  afthma;  I  allow  it  to  be  fo  in  the  fir  it  attacks 
of  the  difeafe  :  but  as  the  difeafe,  by  continuing,  gene- 
rally takes  off  the  plethoric  ftate  of  the  fyftem  ;  fo,  af- 
ter the  difeafe  has  continued  for  fome  time,  I  alledge 
that  blood-letting  becomes  lefs  and  lefs  neceffary. 
iMCCCXC. 

Upon  the  fuppofition  of  afthmatics  being  in  a  pie-. 
thoric  ftate,  purging  might  be  fuppofed  to  prove  a  re- 
medy in  this  diieafe  :  but,  both  becaufe  the  fuppofi- 
tion is  not  commonly  well  founded,  and  becaufe  purg- 
ing is  feldom  found  to  relieve  the  veffels  of  the  thorax, 
this  remedy  has  not  appeared  to  be  well  fuited  to  afth- 
matics ;  and  large  purging  has  always  been  found  to 
do  much  harm.  But  as  afthmatics  are  always  hurt  by 
the  ftagnation  and  accumulation  of  matters  in  the  ali- 
mentary canal,  fo  coftivenefs  muit  be  avoided,  and  an 
open  belly  proves  ufeful.  In  the  time  of  fits,  the  em- 
ployment of  emollient  and  moderately  laxative  glyf- 
4ers*  has  been  found  to  give  confiderable  relief. 

MCCCXCI. 

*  A  clyfterof  milk,  with  a  little  fait,  is  generally  fufficient. 
The  coitivenefs  may  be  removed  by  mucilaginous  laxatives  of  the 


O  F    P  H  Y  S  I  C.  195 

MCCCXCI. 

As  a  flatulency  of  the  ftomach,  and  other  fymp-, 
toms  of  indigeftion,  are  frequently  attendants  of  afth- 
ma,  and  very  troublefome  to  afthmatics;  fo,  both  for 
removing  thefe  iyrnptoms,  and  for  taking  off  all  deter- 
mination to  the  lungs,  the  frequent  ufe  of  gentle  vo- 
mits* is  proper  in  this  dileafc.  In  certain  cafes,  where 
a  lit  was  expected  to  come  on  in  the  coujfeof  the 
night,  a  vomit  given  in  the  evening  has  frequently 
feemed  to  prevent  it. 

MCCCXCI!. 

Bliftering  between  the  fhouldcrs,  or  upon  the 
bread,  has  been  frequently  employed  to  relieve  afth- 
matics  ;  but  in  the  pure  fpafmodic  aflhma  we  treat  of 
here,  I  have  rarely  found  bljfters  ufeful,  either  in  pre- 
venting  or  relieving  fits. 

Mcccxcin. 

Ifiues  are  certainly  ufeful  in  obviating  plethora  ; 
but  as  fuch  indications  feldom  arife  in  cafes  of  afthma, 
fo  iiTues  have  been  feldom  found  ufeful  in  this  difeafe. 
MCCCXC1V. 

As  afthmatic  fits  are  fo  frequently  excited  by  a  tur- 
gefcence  of  the  blood,  fo  the  obviating  and  allaying 
of  this  by  acids  and  neutral  fairs,  feems  to  have  been 
at  all  times  the  objec~b  of  pracliti oners.  See  FLOYER 
on  tho  Aflhma. 

MCCCXCV. 

Although  a  plethoric  ftate  of  the  fyflem  may  feem 
to  difpofe  to  aflhma,  and  the  occailonai  turgefcence 
of  the  blood  may  feem  to  be  frequently  the  exciting 
caufe  of  the  fits ;  yet  it  is  evident,  that  the  difeafe 
mult  have  arifen  chiefly  from  a  peculiar  conftitutioTi 

B,b  2  in 

milder  kind,  as  manna,  cafiia,  &c.  or  by  a  proper  attentive  to  diet, 
cfpecially  by  ufirig  the  pulps  of  particular  fruits,  as  prunes  or  raifms 
boiled  in  barky-water  ;  roatled  applea  eaten  with  brown  fugar,  &:c. 
*   Vomits  otiolit,  in  tliefe  cafes,  to  be  mild.      Some   formulae  cr  - 
them  are  given  in  one  of  the  notes  on  article  185: 


196  PRACTICE 

in  the  moving  fibres  of  the  bronchia?,  difpofing  them 
upon  various  occalions  to  fall  into  a  fpafmodic  con- 
itriction  ;    and  therefore,  that  the  entire  cure  of  the 
difeafe  can  only  be  expected  from  the  correcting  of 
that  predifpofition,  or  from  correcting  the  preterna- 
tural mobility  or  irritability  of  the  lungs  in  that  re- 
fpect. 

MCCCXCVI. 

In  cafes  wherein  this  predifpolition  depends  upon 
original  conformation,  the  cure  mud  be  difficult,  and 
perhaps  irnpcffible;  but  it  may  perhaps  be  moderated 
by  theufe  of  antifpafmodics.  Upon  this  footing,  va- 
rious remedies  of  that  kind  have  been  commonly  em- 
ployed, and  particularly  the  fetid  gums  ;  but  we  have 
not  found  them  of  any  coniiderable  efficacy,  and  have 
obferved  them  to  be  fometimes  hurtful  by  their  heat- 
ing too  much.  Some  other  antifpafmodics  which 
might  be  fuppofed  powerful,  fuch  as  mufe,  have  not 
been  properly  trisd.  The  vitriolic  ether  has  be£o 
found  to  give  relief,  but  its  effects  are  not  lading* 

Mcccxcyii. 

As  in  other  fpafmodic  affections,  fo  in  this,  the  mcfl 
certain  and  powerful  antifpafmodic  is  opium*.  I 
have  often  found  it  effeelua^  and  generally  fafe  5  and 
if  there  have  arifen  doubts  with  refpect  to  its  fafety,- 
I  believe  they  have  arifen  from  not  diilinguilhing  be- 
tween certain  plethoric  and  inflammatory  cafes  of  dyf- 
pncea,  improperly  named  Afthfna,  and  the  genuine 
Ipafmodic  ailhma  we  treat  of  here. 

MCCCXCVIIL 

**  The  great  efficacy  cf  opium,  in  cafes  of  fpafmodic  aflhma,  is 
fally  confirmed  by  experience.  It  ought  to  be  given  in  large  dofes,' 
but  not  often  repeated  in  the  day. ,  It  feems  to  be  moil  ufeful  when 
given  occafionally  to  allay  the  violence  of  the  fit,  or  to  prevent  its 
accelfion.  Thus,  forty  drops  of  laudanum  have  been  frequently 
found  to  relieve  the  fymptoms  when  the  fit  is  violent  ;  or,  when  tak- 
en at  the  approach  cf  the  fit,  to  have  wholly  fupprefied  it,  or  at  leall 
to  have  conliderably  blunted  its  violence. 


OF     PHYSIC.  197 

MCGCXCVIII. 

As  in  many  cafes  this  difeafe  depends  upon  a  pre- 
dlfpolition  which  cannot  becorrecled  by  our  art,  fo  ill 
fuch  cafes  the  patient  can  only  efcape  the  difeafe  by  a- 
voiding  the  cccaiional  or  exciting  caufes,  which. I  have 
endeavoured  to  point  out  above.  It  is,  however,  dif- 
ficult to  giv^-  .-neral  rules  here,  as  different  afth- 
niatics  have  th-ir  different  idiofyncraiies  with  refpecl: 
to  externals.  Thus,  one  afthmatic  finds  himfelf  eafieft 
living  in  the  midft  of  a  great  city,  while  another  can- 
not breathe  but  in  the  free  air  of  the  country.  In  the 
latter  cafe,  however,  moil  afthmatics  bear  the  air  of  a 
low  ground,  if  tolerable  free  and  drya  better  than  that 
of  the  mountain. 

MCCCXC1X. 

In  diet,  alfo,  there  is  forne  difference  to  be  made 
with  refpecl  to  different  afthmatics.  None  of  them 
bear  a  large  or  full -meal,  or  any  food  that  is  of  flow 
and  difficult  folution  in  the  ftomach  ;  but  many  of 
them  bear  animal-food  of  the  lighter  kinds,  and  in 
moderate  quantity.  The  ufe  of  vegetables  which  rea- 
dily prove  flatulent,  are  always  very  hurtful.  In  re- 
cent afthma,  and  efpecially  in  the  young  and  pletho- 
ric, a  fpare,  light,  and  cool  diet  is  proper,  and  com- 
monly neceffary  ;  bur,  after  the  difeafe  has  continued 
for  years,  afthmatics  commonly  bear,  and  even  require, 
a  tolerably  full  diet,  though  in  all  cafes  a  very  full  diet: 
is  very  hurtful. 

Mecca 

In  drinking,  water,  or  cool  watery  liquors,  is  the 
only  fafe  and  fit  drinks  for  afthmatics ;  and  ail  liquors 
ready  to  ferment  and  become  flatulent,  are  hurtful  to 
them.  Few  afthmatics  can  bear  any  kind  of  ftrong 
drir.k  ;  and  any  excefs  in  fuch  is  always  very  hurtful 
to  them.  As  afthmatics  are  commonly  hurt  by  taking- 
warm  or  tepid  drink;  fo,  both  upon  that  account,  and 
upon  account  of  the  liquors  weakening  the  nerves  of 

the 


PRACTICE 

the  ftomach,   neither  tea  nor  coffee  is  proper  in  this 
difeafe. 

MCCCCI. 

Adhmatics  commonly  bear  no  bodily  motion  eafi- 
ly  but  that  of  the  mod  gentle  kind.  Riding,  howe- 
ver, on  horfeback,  or  going  in  a  carriage,  and  cfpeci- 
ally  failing,  are  very  often  ufeful  to  adhmatics. 


C     II     A    P.       VII. 

OF    THE    CHINCOUGH,     OR    HOOPING- 
COUGH. 

MCCCCII. 

THIS  difeafe  is  commonly  epidemic,  and  manifed- 
ly  contagious.  It  feems  to  proceed  from  a  con- 
tagion of  a  fpeciftc  nature,  and  of  a  fmgular  quality. 
It  does  not  like  mod  other  contagions,  necefianly  pro- 
duce a  fever  j  nor  does  it,  like  mod  others,  occsiion 
any  eruption,  or  produce  otherwife  any  evident  change 
in  the  date  of  the  human  fluids.  It  has,  in  common 
with  the  catarrhal  contagion,  and  with  that  of  the 
jneafles,  a  peculiar  determination  to  the  lungs ;  but 
•with  particular  effects  there,  very  different  from  thofe 
of  the  other  two ;  as  will  appear  from  the  hidory  of 
this  difeafe  now  to  be  delivered. 
MCCCCIII. 

This  contagion,  like  feveral  others,  affects  perfons 
but  once  in  the  courfe  of  their  lives  ;  and  therefore, 
necelfarily,  children  are  mod  commonly  the  fubjects  of 
this  difeafe  :  but  there  are  many  indances  of  it  occur- 
ring in  perfons  confiderably  advanced  in  life ;  though 
it  is  probable,  that  the  further  that  perfons  arc  advanc- 
ed 


OF      PHYSIC.  199- 

cd  in  life,  they  are  the  lefs  liable  to  be  affe&ed  with 
this  contagion. 

MCCCCIV. 

The  difeafe  commonly  comes  on  with  the  ordinary 
fymptoms  of  a  catarrh  arifing  from  cold  ;  and  often* 
for  many  days,  keeps  entirely  to  that  appearance  j  and 
I  have,  had  inftanccs  of  a  difeafe  which  though  evi- 
dently arifing  from  the  chincough  contagion,  never 
put  on  any  other  form  than  that  of  a  common  ca- 
tarrh. 

This,  however,  feldom  happens ;  for,  generally,  in 
the  fecond,  and  at  fartheft  in  the  third,  week  after 
the  attack,  the  difeafe  puts  on  its  peculiar  and  charac- 
teriitic  fympcom,  a  convulfive  cough.  This  is  a 
cough  in  which  the  exfpiratory  motions  peculiar  to 
coughing  are  made  with  more  frequency,  rapidity, 
and  violence,  than  ufual.  As  thrfe  circumftances, 
however,  in  different  inftances  of  coughing,  are  in 
very  different  degrees ;  fo  no  exac"i  limits  can  be  put 
to  determine  when  the  cough  can  be  ftrictly  faid  to 
be  convulliye  ;  and  it  is  therefore  efpecially  by  ano- 
ther circumftance  that  the  chincough  is  diftinguifhed 
from  every  other  form  of  cough.  This  circumftance 
is,  when  many  exfpiraiory  motions  have  been  convul- 
fively  made,  and  thereby  the  air  is  in  great  quantity 
thrown  out  from  the  lungs,  a  full  infpiration  is  necei- 
farily  and  fuddehly  made ;  which,  by  the  air  rufhing 
in  through  the  glottis  with  unufual  velocity,  gives  a 
peculiar  found.  This  found  is  fomewhat  different  in 
different  cafes,  but  is  in  general  called  a  Hoop  ;  ancf 
from  it  the  whole  of  the  difeafe  is  called  the  Hooping 
Cough.  When  this  fonorous  infpiration  has  happen- 
ed, the  convulfive  coughing  is  again  renewed,  and  con- 
tinues in  the  fame  mariner  as  before,  till  a  quantity  of 
mucus  is  thrown  up  from  the  lungs,  or  the  contents  of 
the  itomach  are  thrown,  up  by  vomiting.  Either  of 
r.hcfe  evacuations  commonly  puts  an  end  to  the 

coughing, 


PRACTICE 

coughing,  and  the  patient  remains  free  from  it  for* 
fome  time  after.  Sometimes  it  is  only  after  feveral 
alternate  fits  of  coughing  and  hooping  that  expectora- 
tion or  vomiting  takes  place ;  but  it  is  commonly  af- 
ter the  fecond  coughing  that  thefe  happen,  and  put 
an  end  to  the  fit. 

MCCCCV. 

When  the  difeafe,,  in  this  manner,  has  taken  its 
proper  form,  it  generally  continues  for  along  time  af- 
ter, and  generally  from  one  month  to  three  ;  but 
fometimes  much  longer,  and  that  with  very  various 
circumflances. 

MCCCCVI. 

The  fits  of  coughing  return  at  various  intervals, 
rarely  obferving  any  exact  period.  They  happen  fre- 
quently in  the  courie  of  the  day,  and  more  frequently 
riill  in  the  courfe  of  the  night.  The  patient  has  com- 
monly fome  warning  of  their  coming  on  •  and,  to  a- 
void  that  violent  and  painful  concuilion  which  the 
coughing  gives  to  the  whole  body,  he  clings  fail  to 
any  thing  that  is  near  to  him,  or  demands  to  be  held 
fafl  by  any  perfon  that  he  can  come  at. 

When  the  fit  is  over,  the  patient  fometimes  breathes 
faft,  and  feems  fatigued  for  a  little  after  :  but  in  many 
this  appears  very  little  ;  and  children  are  commonly  fo 
entirely  relieved,  that  they  immediately  return  to 
their  play,  or  what  elfe  they  were  occupied  in  before. 
MCCCCVII. 

If  it  happens  that  the  fit  of  coughing  ends  in  vo- 
miting up  the  contents  of  the  ftomach,  the  patient  is 
commonly  immediately  after  feized  with  a  ilrong 
craving  and  demand  for  food,  and  takes  it  in  very 
greedily. 

MCCCCVIII. 

At  the  firft  coming  on  of  this  difeafe,  the  expecto- 
ration is  fometimes  none  at  all,  or  of  a  thin  mucus 
only  ;  and  while  this  co  .  to  be  the  cafe,  the  fits 

of 


O  F      P  H  Y  S  I  C.  201 

©f  coughing  are  more  violent,  and  continue  longer; 
but  commonly  rhe  expectoration  foori  becomes  con- 
liderabie,  and  a  very  thick  mucus,  often  in  great 
quantity,  is  thrown  up ;  and  as  this  is  more  readily 
brought  up,  the  fits  of  coughing  are  of  fhorter  dura- 
tion. 

MCCCCIX. 

The  violent  fits  of  coughing  frequently  interrupt 
the  free  tranfmiffion  of  the  blood  through  the  lungs, 
and  thereby  the  free  return  of  blood  from  the  veffeis 
of  the  head.  This  occafions  that  turgefcence  and  fuf- 
fufion  of  face  which  commonly .  attends  the  fits  of 
coughing,  and  feems  to  occafioil  alfo  thofe  eruptions 
of  blood  from  the  nofe,  and  even  from  the  eyes  and 
ears,  which  fometimes  happen  in  this  difcafe. 
MCCCCX.  ; 

This  difeafe  often  takes  place  in  the  manner  we 
have  now  defcribed,  without  any  pyrexia  attending 
it;  but,  though  Sydenham  had  feldom  obferved  it, 
we  have  found  the  difeafe  very  frequently  accompani- 
ed with  pyrexia,  fometimes  from  the  very  beginning, 
but  more  frequently  only  after  the  difeafe  had  conti- 
nued for  fome  time.  When  it  docs  accompany  the 
difeafe,  we  have  not  found  it  appearing  under  any  re- 
gular intermittent  form.  It  is  conitantly  in  fome  de- 
gree prefent ;  but  with  evident  exacerbations  towards 
evening,  continuing  till  next  morning. 
MCCCCXI. 

A  nether  fymptom  v  ery  frequently  attending  the  chin- 
1  cough,  is  a  difficulty  of  breathing ;  and  that  not  only 
limmediately  before  and  after  fits  of  coughing,  but  as 
Iconflantly  prefent,  though  in  different  degrees  in  dif- 
ferent perfons.  I  have  hardly  ever  feen  an  inflance  of 
a  fatal  chincough,  in  which  a  confiderable  degree  of 
pyrexia  and  dyipnoea  had  not  been  for  fome  time  con- 
Itantly  pretent. 

VOL.  II.  C  c  MCCCCXIL 


201  P  R  A 


MCCCCXIF. 

When  by  the  power  of  the  contagion  this  difeafe 
has  once  taken  place,  the  fits  of  coughing  are  often  re- 
peated, without  any  evident  exciting  caufe  :  but,  in 
many  cafes,  the  contagion  may  be  confidered  as  giv- 
ing a  predifpoiition  only  ;  and  the  frequency  of  fits 
depends  in  feme  meafure  upon  various  exciting  cau- 
fes  ;  fuch  as,  violent  exercife ;  a  full  rneal ;  the  having 
taken  in  food  of  difficult  foiution  ;  irritations  of  the 
lungs  by  dud,  fnioke,  or  difagreeable  odours  of  a  ilrong 
kind  ;  and,  efpecially  any  confiderable  emotion  of  the 
mind. 

MCCCCXIIL 

Such  are  the  chief  circumftances  of  this  difeafe, 
and  it  is  of  various  event ;  which,  however,  may  be 
commonly  forefeen  by  attending  to  the  following 
confederations. 

The  younger  that  children  are,  they  are  in  the 
greater  danger  from  this  difeafe;  and  of  thofe  to  whom 
it  proves  fatal,  there  are  many  more  under  two  years 
old  than  above  it. 

The  older  that  children  are,  they  are  the  more  fe- 
cure  againil  an  unhappy  event  ;  and  this  I  hold  to  be 
a  very  ^general  rule,  though  I  own  there  are  many  ex- 
ceptions to  it. 

Children  born  of  phthifical  and  afthmatic  parents 
are  in  the  greateft  danger  from  this  difeafe. 

When  the  difeafe,  beginning  in  the  form  of  a  ca- 
tarrh, is  attended  with  fever  and  difficult  breathing, 
and  with  little  expectoration,  it  often  proves  fatal, 
without  taking  on  the  form  of  the  hooping  cough  ; 
but,  in  rnoft  of  fuch  cafes,  the  coming  on  of  the  con- 
vulfive  cough  and  hooping,  bringing  on  at  the  fame 
time  a  more  frequent  expectoration,  generally  removes 
the  danger. 

When  the  difeafe  is  fully  formed,  if  the  fits  are  nei- 
ther ficqueut  nor  violent,  with  moderate  expectora- 
tion, 


OF    PHYSIC.  203 

tion,  and  the  patient,  during  the  intervals  of  the  fits, 
is  eafy,  keeps  his  appetite,  gets  deep,  and  is  without 
fever  or  difficult  breathing,  the  difeafe  is  attended  with 
no  danger ;  and  thefe  circumftances  becoming  daily 
more  favourable,  the  difeafe  very  foon  fpontaneoufly 
terminates. 

An  expectoration,  either  very  fcunty  or  very  copi- 
ous, is  attended  with  danger  5  efpecially  if  the  latter 
circumftance  is  attended  with  great  difficulty  of  breath- 
ing. 

Thofe  cafes  in  which  the  fits  terminate  by  a  vomit- 
Ing,  are  immediately  followed  by  a  craving  of  food, 
are  generally  without  danger. 

A  moderate  hemorrhagy  from  the  nofe  often  proves 
falutary ;  but  very  large  heinorrhagics  are  generally 
very  hurtful. 

This  difeafe  corning  upon  perfons  under  a  flate  of 
much  debility,  has  very  generally  an  unhappy  event. 

The "  danger. of  this  difeafe  fometimes  arifes  from, 
the  violence  of  the  fits  of  coughing,  oecafioning  apo- 
plexy, epilepfy,  or  immediate  fuffocation :  but  thefe 
accidents  are  very  rare ;  and  the  danger  of  the  difeafe 
feems  generally  to  be  in  proportion  to  the  fever  and 
dyfpncea  attending  it. 

MCCCGXIV. 

The  cure  of  this  difeafe  has  been  always  confidered 
as  difficult,  whether  the  purpofe  be  to  obviate  its  fatal 
tendency  when  it  is  violent,  or  merely  to  ihorren  the 
courfe  of  it  when  it  is  mild.  When  the  contagion  is 
recent,  and  continues  to  act,  we  neither  know  how 
to  correct,  nor  how  to  expel  it ;  and  therefore  the  dif- 
eafe neceilarily  continues  forfome  time:  but  it  is  pro- 
Jbab!e5  that  the  contagion  in  this  us  in  other  initance^ 
Ceafes  at  length  to  act ;  and  that  then  the  difeafe  con- 
tinues, as  in  other  convulfive  affections,  by  the  power 
of  habit  alone.  C  c  2 

MCCCCXV. 


204  PRACTICE 

v. 

MCCCCXV. 

From  this  view  of  the  matter  I  maintain,  that 
pra&ife  mud  be  different,  and  adapted  to  two  differ- 
ent indications,  according  to  the  period  of  the  difeafe. 
At  the  beginning  of  the  difeafe,  and  for  fome  time  af- 
ter, the  remedies  to  be  employed  muft  be  fuch  as  may 
obviate  the  violent  effeds  of  the  difeafc,  and  the  fatal 
tendency  of  it;  but,  after  the  difeafe  has  continued 
for  fome  time,  and  is  without  any  violent  fymptoms, 
tVie  only  remedies  which  can  be  required  are  thofe 
which  may  interrupt  its  courfe,  and  put  an  entire  flop 
to  itfooner  than  it  would  have  fpontaneoufly  ccafed. 

Mccccivi. 

For  anfwering  the  firit  indication.  In  plethoric  fub- 
jects,  or  in  others,  when  from  the  circumftances  of 
the  cough  and  firs  it  appears  that  the  blood  is  diffi- 
cultly tr an i'mittx-d  through  the  lungs,  blood-letting* 
is  a  neceflafy  i^m'-Jy ;  and  it  may  be  even  neceflhry. 
to  repeat  it,  efptciaily  in  the  beginning  of  the  diieaie  : 
but,  as  fpafrnodic  affections  do  not  commonly  admit 
of  much  bleeding,  ib  it  is  feldom  proper  in  the  chin- 
eou^h  to  repeat  thjs  remedy  often.  \ 
M  CCCCXV1L 

As  cofcivenefs  frequently  attends  this  difeafe,  fo  it- 
is  neceffary  to  obviate  or  remove  it  by  laxatives  em- 
ployed;  and  keeping  an  open  belly  is  generally  ufe- 
ful  :  but  large  evacuations  in  this  way  are  commonly, 
hurtfulf. 

MCCCCXVIII. 

To  obviate  or  remove  the  inflammatory  determiiir 

ation' 

*  Bleeding,  in  thefc  cafes,  isbeft  performed  by  leeches  ;  and  they 
feem  to  give  greater  relief  when  applied  about  the  neck  than  on  any 
other  part. 

•j-  In  general,  the  belly  may  be  kept  open  by  a  proper  attention 
to  diet  :  roaited  apples,  eaten  with  brown  fugar,  flewed  prunes,  an4? 
other  firrri'ar  food,  which,  children  generally  devour  with  avidity,  fuf-^ 
ficiently  anfwcr  the  purpofe  of  removing  or  preventing  coHivcncfs., 


QF    PUTS  I  C. 

ation  to  the  lungs  that  fornetimes  occur5  in  this  dif- 
enfej  bliftering  is  often ufefui.,  and  even  repeated  blif- 
tering  has  been  of  fervice ;  but  iffucs  havs  not  fo 
much  effect,  and  fhould  by  no  means  fuperfede  the  re- 
peated bliftering  that  may  be  indicated.  When  biif- 
ters  are  proper,  they  are  more  eifeelual  when  applied 
to  the  thorax,  than  when  applied  to  any  diftant  parts. 

MCCCCXIX 

Of  all  other  remedies,  emetics  are  the  molt  ufcul  in 
this  difeafe  ;  both  in  general  by  interrupting  the  re- 
turn of  fpnf  modi  c  afFe&ions,  and  in  particular  by  de- 
termining very  powerfully  to  the  furfacc  of  the  body, 
and  thereby  taking  off  determinations  to  the  lungs. 
For  thcfe  purpofes,  I  think,  full  vomiting  is  frequently 
to  be  employed  ;  and,  in  the  intervals  neceifary  to  b-2 
left  between  the  times  of  full  vomiting,  naufeating  do- 
fcs  of  the  antimoniai  emetics  may  be  ufefui*.  I  have 
never  found  thtjulphur  auralum,  fo  much  praifed  by 
Clofiius,  to  be  a  convenient  medicine,  on  account  of 
the  uncertainty  of  its  dofe  ;  and  the  tartar  emetic,  cm- 
ployed  in  the  manner  directed  by  the  late  Dr.  Fotijer- 
gill,  has  appeared  to  be  more  ufefui. 

MCCCCXX. 

*  The  method  of  giving  tartar  emetic  in  naiffcattng  dofes  has 
ncen  frequently  mentioned  in  preceding  notes  ;  but  in  cafes  of  chin- 
rou^h,  where  children  are  generally  our  patients,  we  arc  under  the 
j;ec^iTity  of  varving  the  do  fcs  to  the  age  and  conftitutj.m.  When 
the  child  is  under  a  year  old,  we  ought  to  ufc  the  weak  folution  of 
tartar  emetic,  fpecified  in  the  end  of  the  lafl  note  on  article  185,  in 
repeated  dofes  of  a  table- fpoonful  every  ten  or  fifteen  minutes,  till 
it  operates.  Large  dofes,  efpecially  to  young  children,  are  frequent- 
ly attended  with  dangerous  confequences,  of  which  the  following 
cafe  is  a  fuSicftnt  proof. 

'I'o  ?  dhild  not  ten  months  old,  that  laboured  under  thechiocougli, 
half  a  gr::in  of  tartar  emetic  was  giveu  in  a  little  cinnamon-water. 
A  violent  vomiting  was  produced,  and  the  child  died  fuddcnly,  dur 
ir.g  the  aflion  of  the  medicine  :  on  infpecliing  the  body  after  death, 
we  found  the  ftomaeh  burft,  there  being  in  it  a  laceration  that  ad- 
mitted two  fingers.  The  infpe&ion  of  th.'s  body  has 'always  made 
me  extremely  cautious  in  admiriiftering  emetics  to  young  children. 


266  PRACTICE 

MCCCCXX. 

Thefe  are  the  remedies  to  be  employed  in  the  firft 
ftage  of  the  difeafe  for  obviating  its  fatal  tendency, 
and  putting  it  into  a  fafe  train.  But  in  the  fecond 
ftage,  when  I  fnppofe  the  contagion  has  ceafed  to  act, 
and  that  the  difeafe  continues  merely  by  the  power  of 
habit,  a  different  indication  arifes,  and  different  re- 
medies are  to  be  employed. 

MCCCCXXI. 

This  difeafe,  which  often  continues  for  a  long  time., 
does  not,  in  my  opinion,  continue  during  the  whole 
of  that  time  in  ccnfequence  of  the  contagion's  re- 
maining in  the  body,  and  continuing  to  ad  in  it. 
That  the  difeafe  does  often  continue  long  after  the 
contagion  has  ceafed  to  a6t,  and  that  too  by  the  pow- 
er of  habit  alone,  appears  tome  probable  from  hence, 
that  terror  has  frequently  cured  the  difeafe  ;  that  any 
confiderable  change  in  the  ftate  of  the  fyitem,  fuch  as 
the  coming  on  of  the  frnall-pox,  has  alfo  cured  it  5  and 
laftly,  that  it  has  been  cured  by  antifpafmodic  and  to- 
nic medicines  ;  whilft  none  of  all  thcfe  means  of  cure 
can  be  fuppofed  either  to  ported  or  to  expel  a  mor- 
bific matter,  though  they  are  evidently  fuited  to 
change  the  ftate  and  habits  of  the  nervous  fyftem. 
MCCCCXXII. 

From  this  view  we  are  directed  to  the  indication 
that  may  be  formed,  and  in  a  great  meafure  to  the  re- 
medics  which  may  be  employed  in  what  we  fuppofe  to 
be  the  fecond  ftage  of  the  difeafe.  It  may  perhaps  be 
alledged,  that  this  indication  of  fhortcning  the  courfe 
of  the  difeafe  is  not  very  important  or  necefTary,  as  ic 
fuppofes  that  the  danger  or  violence  is  over,  and,  in 
confequence,  that  the  difeafe  will  foon  fpontaneoufly 
ceafe.  The  laft  fuppofition,  however,  is  not  well 
founded ;  as  the  difeafe,  like  many  other  qonvulfive 
and  fpafmodic  affeclions,  may  continue  for  a  long 
time  by  the  power  of  habit  alone,  and  by  ths  repeti- 
tion 


O  F    P  H  Y  S  I  C.  207 

tion  of  paroxyfms  may  have  hurtful  effects;  more  efpe- 
cially  as  the  violence  of  paroxyfms,  and  therefore 
their  hurtful  effects,  may  be  much  aggravated  by  va- 
rious external  caufes  that  may  be  accidentally  applied. 
Our  indication,  therefore,  is  proper;  and  \ve  proceed 
to  conlider  thcfeveral  remedies  wftich  may  be  employ-* 
ed  to  anfwer  it. 

MCCCCXXIII. 

Terror  may  pofubly  be  a  powerful  remedy,  but  it  is 
difficult  to  meafure  the  degree  of  it  that  Ihall  bs  pro- 
duced ;  and,  as  a  flight  degree  of  it  may  be  ineffectual* 
and  a  high  degree  of  it  dangerous,  I  cannot  propofs 
to  employ  it. 

MCCCCXXIV. 

The  other  remedies  which  we  fuppofe  fuited  to  our 
fecond  indication,  and  which  indeed  have  been  fre- 
quently employed  in  this  difeafe,  are  antifpafmodics 
or  tonics. 

Of  the  antifpafmodics,  caflo-r  has  been  particularly 
recommended  by  Dr.  Morris ;  but  in  many  trials  we 
have  not  found  it  effectual. 

With  more  probability  rnufk  has  been  employed  : 
but  whether  it  be  from  our  not  having  it  of  a  genuine 
kind,  or  not  employing  it  in  fufficiently  large  dofes,  I 
cannot  determine  ;  but  we  have  not  found  it  common- 
ly fuccefsful.  Of  antifpafrnodics,  the  moft  certainly 
powerful  is  opium  :  and  when  there  is  no  confident 
ble  fever  or  difficulty  of  breathing  prefent,  opium  has 
often  proved  ufcful  in  moderating  the  violence  of  the 
chincough  ;  but  I  have  not  known  it  employed  fo  as 
entirely  to  cure  the  difeafe. 

If  hemlock  \v«$  proved  a  remedy  in  this  difeafe,  as 
we  muft  believe  from  Dr.  Butter's  accounts,  I  agree 
with  that  author,  that  it  is  to  be  coniidered  as  an  an- 
tifpafrnodic.  Upon  this  fuppofition,  it  is  a  probable 
remedy  ;  and  from  the  accounts  of  Dr.  Butler  and 
fome  others,  it  feems  to  have  been  often  ufeful :  but, 

in 


2oS  P  R  A  C  T  I  C  £ 

in  our  trials,  it  has  often  difappointed  us,  perhaps 
from  the  preparation  of  it  not  having  been  always 
proper*. 

MCCCCXXV. 

Of  the  tonics,  I  qgnfider  the  cupmofs,  formerly  ce- 
lebrated, as  of  this  kind  ;  as  alfo  the  bark  of  the  mif- 
Ictoe  ;  but  I  have  had  no  experience  of  either,  as  I 
have  always  trufled  to  the  Peruvian  bark.  I  conlider 
the  ufe  of  this  medicine  as  the  moft  certain  means  of 
curing  the  diieafe  in  its  fecond  flage  ;  and  when  there 
has  been  little  fever  prefent,  and  a  fufficient  quantity 
of  the  bark  has  been  given,  it  has  feldorn  failed  of 
foon  putting  an  end  to  the  difeafe. 
MCCCCXXVI. 

When  convulfive  diforders  may  be  fuppofed  to  con- 
tinue by  the  force  of  habit  alone,  it  has  been  found 
that  a  considerable  change  in  the  whole  of  the  cir- 
cumftances  and  manner  of  life  has  proved  a  cure  of 
fuch  difeafes  ;  and  analogy  has  applied  this  in  the 
cafe  of  the  chincough  fo  far,  that  a  change  of  air  has 
been  employed,  and  fuppofed  to  be  ufeful.  In  feve- 
ral  inftances  I  have  obferved  it  to  be  fo  ;  but  I  have 
never  found  the  effects  of  it  durable,  or  fufficient  to 
put  an  entire  ilop  to  the  difeafe. 

BOOK 

*  Experience  has  not  found  that  any  of  the  antifpafmodics  have 
ever  been  employed  with  much  advantage  in  this  difeafe.  Ail  of 
them  are  extremely  naufeous,  and  corifequently  difficultly  given  to 
children  who  cannot  well  f wallow  pills. 


OF    PHYSIC;  209 


BOOK    IIL         SECT.     III. 

OF  THE  SPASMODIC  AFFECTIONS  IN  THE 
NATURAL  FUNCTIONS. 

CHAP.     VIIL 

OF  THE  PYROSIS,  OR  WHAT  IS  NAMED  IN 
SCOTLAND  THE  WATER-BRASH. 

MCCCCXXVII. 

THE  painful  fenfations  referred  to  the  ftomach,  and 
which  are  probably  occaiioned  by  real  affedions 
of  this  organ,  are  of  different  kinds.  Probably  they 
proceed  from  affections  of  different  natures,  and  ihould 
therefore  be  diflinguifhed  by  different  appellations  ; 
'but  I  muft  own  that  the  utmoft  precifion  in  this  mat- 
ter will  be  difficult.  In  my  effay  towards  a  methodi- 
cal Nofology,  I  have,  however,  attempted  it.  For 
thofe  pains  that  are  either  acute  and  pungent,  or  ac- 
companied with  a  fenfe  of  diflenfion,  or  with  a  fenfe  of 
conftridlion,  if  they  are  at  the  fame  time  not  attended 
with  any  fenfe  of  acrimony  or  heat,  I  employ  the  ap- 
pellation of  Gaftrodynia.  To  exprefs  thofe  painful  or 
uneafy  fenfations  which  feem  to  arife  from  a  fenfe  of 
acrimony  irritating  the  part,  or  from  fuch  a  fenfe  of 
heat  as  the  application  of  acrids,  whether  externally 
or  internally  applied,  often  gives,  I  employ  the  term 
of  Cardialgia ;  and  by  this  I  particularly  mean  to  de- 
note thofe  feelings  which  are  exprelfed  by  the  term 
Heartburn  in  the  Englifh  language.  I  think  the  term 
Soda  has  been  commonly  employed  by  practical  wri- 
ters, to  exprefs  an  affedion  attended  with  feelings  of 
the  latter  kind, 

VOL.  II.  D  d          MCCCCXXVIII. 


PRACTICE 

MCCCCmFVIII. 

Bciidc  the  pains  denoted  by  the  terms  Gaftrodinia, 
Pcriadynia,  Cardialgia,  and  Soda,  there  is,  I  think, 
another  painful  ienfation  different  from  all  of  thefe, 
which  is  named  by  Mr.  Sauvages  Pyrofis  Suecica  ; 
and  his  account  of  it  is  taken  from  Linnaeus,  who 
names  it  Cardialgia  Sputatoria.  Under  the  title  of 
Py rolls  Mr.  Sauvages  has  formed  a  genus,  of  which 
the  whole  of  the  fpccies,  except  the  eighth,  which  he 
gives  under  the  title  of  Pyrofis  Suecica,  .are  all  of 
them  fpecies  of  the  Gaftrodynia  or  of  the  Cardialgia  ; 
and  if  there  is  a  genus  to  be  formed  under  the  title  of 
Pyrofis,  it  can  in  my  opinion  comprehend  only  the  fpe- 
cies I  have  mentioned.  In  this  cafe,  indeed,  I  own 
that  the  term  is  not  very  proper  ;  but  my  averfion  to 
introduce  new  names  has  made  me  continue  to  employ 
the  term  of  Mr.  Sauvages. 

MCCCCXXIX. 

The  Gaftrodynia  and  Cardialgia  I  judge  to  be  for 
the  mod  part  fymptomatic  affections  ;  and  therefore 
have  given  them  no  place  in  this  work  :  but  the  Py- 
rofis, as  an.  idiopathic  difeafc,  and  never  before  treat- 
ed of  in  any  fyftcm,  I  propofe  to  treat  of  here. 
MCCCCXXX. 

It  is  a  difeafe  frequent  among  people  in  lower  life, 
but  occurs  alfo,  though  more  rarely,  in  people  of 
better  condition.  Though  frequent  in  Scotland,  it  is 
by  no  means  fo  frequent  as  Linnaeus  reports  it  to  be 
in  Lapland.  It  appears  moil  commonly  in  perfons 
under  middle  age,  but  fcldom  in  any  perfons  before 
the  age  of  puberty.  When  it  has  once  taken  place, 
it  is  ready  to  recur  occafionally  for  a  long  time  after; 
but  it  feldom  appears  in  perfons  confiderably  advanc- 
ed in  life.  It  affects  both  fexes,  but  more  fre- 
quently the  female.  It  fometimes  attacks  pregnant 
women,  and  fome  women  only  when, they  are  in  that 
condition.  Of  other  women,  it  more  frequently  af- 
fects 


OF      PHYSIC.  an 

feds  the  unmarried  ;  and  of  the  married,  mod  fre- 
quently the  barren.  I  have  had  many  inftances  of 
its  occurring  in  women  labouring  under  afluor  albus. 

MCCCCXXXI. 

The  fits  of  thisdifeafe  ufuallycome  on  in  the  morn- 
ing and  forenoon,  when  the  flomach  is  empty.  The 
firit  fymptcm  of  it  is  a  pain  at  the  pit  of  the  fiomach, 
with  a  fenfe  of  confthclion,  as  if  tne  itomach  was 
drawn  towards  the  back  ;  the  pain  is  increafed  by 
raifing  the  body  inco  an  creel  pofture,  and  therefore 
the  body  is  bended  forward.  This  pain  is  often  very 
fevere  ;  and,  after  continuing  for  feme  time,  it  brings 
on  an  eructation  of  a  thin  watery  fluid  in  coniiderable 
quantity.  This  fluid  has  fometimes  an  aciid  tafte, 
but  is-  very  often  abfoiutely  iniipid.  The'  emulation 
is  for  fome  time  frequently  repeated  ;  and  do,es  not 
immediately  give  relief  to  the  pain  which  preceded 
it,  but  does  fo  at  length,  and  puts  an  end  to  the  fit. 
MCCCCXXXIL 

The  fits  of  this  difeafe  commonly  corne  on  without 
any  evident  exciting  caufe ;  and  I  have  not  found  it 
fleadily  connected  with  any  particular  diet.  It  at-, 
tacks  peribns  ufing  animal  food,  but  1  think  more  fre- 
quently thofe  living  on  milk  and  farinacea.  It  feems 
often  to  be  excited  by  cold  applied  to  the  lower  ex- 
tremeties  :  and  is  readily  excited  by  any  confiderabie 
emotion  of  mind.  It  is  often  without  any  fymptoms, 
of  dyfpepfia. 

MCCCCXXXUL 

The  nature  of  this  afFedion  is  not  very  obvious: 
but  I  think  it.  may  be  explained  in  this  manner  :  It 
feems  to  begin  by  a  fpafrn  of  the  mulcular  fibres  of 
die  ftomach  ;  which  is  afterwards,  in  a  certain  man- 
ner, communicated  to  the  blood-veflels  and  exhahnts, 
fo  as  to  increafe  the  impetus  of  the  fluids  in  thefe  vef- 
fels,  while  a  conftridion  takes  place  on  their  extremi- 
ties. While  therefore  the  increafed  impetus  deter- 
D  d  2  mines 


P  R  A  C  T  ICE 

mines  a  greater  quantity  than  ufual  of  fluids  into  thofe 
veflels,  the  conftri&ion  upon  their  extremeties  allows 
only  the  pure  watery  parts  to  be  poured  out,  analogous, 
as  I  judge,  in  every  refpeft,  to  what  happens  in  the 
diabetes  hyftericus. 

MCCCCXXXIV. 

The  practice  in  this  difeafe  is  as  difficult  as  the  the- 
ory. The  paroxyfm  is  only  to  be  certainly  relieved 
by  opium.  Other  antifpafmodics,  as  vitriolic  ether 
and  volatile  alkali,  are  fometimes  of  fervice,  but  not 
conftandy  fo.  Although  opium  and  other  antifpaf- 
modics  relieve  the  fits,  they  have  no  effect  in  prevent- 
ing their  recurrence.  For  this  purpofe,  the  whole  of 
the  remedies  of  dyfpepfia  have  been  employed  without 
fuccefs.  Of  the  ufe  of  the  nux  vomica,  mentioned  ?.?. 
a  remedy  by  Linnaeus,  I  have  had  no  experience. 


CHAP.     IX. 


OF    THE     COLIC. 

MCCCCXXXV. 

THE  principal  fymptom  in  this  difeafe  is  a  pain 
felt  in  the  lower  belly.  It  is  felclom  fixed  and1 
pungent  in  one  part,  but  is  a  painful  diftenfion  in 
fome  meafu're  fpreading  over  the  whole  of  the  belly  ; 
and  particularly  with  a  fenfc  of  twilling  or  wringing 
round  the  navel.  At  the  fame  time,  with  this  pain, 
the  navel  and  teguments  of  the  belly  are  frequently 
drawn  inwards,  and  often  the  mufcles  of  the  belly  are 
fpafmodically  contracted,  and  this  in  feparate  portions, 
Divine  the  appearance  of  a  bag  full  of  round  balls. 

MCCCCXXXVI. 


OF     PHYSIC  sig 

MCCCCXXXVI. 

Such  pains,  in  a  certain  degree,  fometiines  occur  in 
cafes  of  diarrhoea  and  cholera  ;  but  thefe  are  lefs  vio- 
lent and  more  traniitory,  and  are  named  Gripings. 
It  is  only  when  more  violent  and  permanent,  and  at- 
tended with  coftivenefs,  that  they  conftitute  colic. 
This  is  alfo  commonly  attended  with  vomiting.,  which 
in  many  cafes  is  frequently  repeated,  efpecially  when 
any  thing  is  taken  down  into  the  flomach  ;  and  in 
fuch  vomitings,  not  only  the  contents  of  the  flomach 
are  thrown  up,  but  alfo  the  contents  of  the  duodenum, 
and  therefore  frequently  a  quantity  of  bile. 
MCCCCXXXVIL 

In  fome  cafes  of  colic,  the  perifcaltic  motion  is  in- 
verted through  the  whole  length  of  the  alimentary 
canal,  in  fuch  a  manner  that  the  contents  of  the  great 
guts,  and  therefore  ftercoracecus  matter,  is  thrown  up 
t>y  vomiting  ;%and  the  lame  inverfion  appears  flill 
more  clearly  from  this,  that  what  is  thrown  into  the 
rectum  by  glyfter  is  again  thrown  out  by  the  mouth- 
In  thefe  circumftances  of  inverfion  the  -ctiieafe  has  been 
named  Ileus,  or  the  Iliac  Pailion  ;  and  this  has  been 
fuppofed  to  be  a  peculiar  difeafe  diftincl:  from  colic  ; 
but  to  me  it  appears  that  the  two  difcafes  are  owing  to  ( 
the  fame  proximate  caufe,  and  have  the  fame  Symp- 
toms, only  in  a  different  degree. 

MGCCCXXXVIII. 

The  colic  is  often  without  any  pyrexia  attending  it: 
Sometimes,  however,  an  inflammation  comes  upon 
the  part  of  the  interline  efpecially  affected  ;  and  this 
inflammation  aggravates  all  the  fymptoms  of  the  dif- 
eafe, being  probably  what  brings  on  the  moft  confi- 
derable  inverfion  of  the •  pcriftaltic  motion;  and,  as 
the  ftercoraceous  vomiting  is  what  efpecially  diiiin- 
guimcs  the  ileus,  this  has  been  confidered  as  always 
depending  on  an  inflammation  of  the  interlines.  How- 
ever, I  can  affirm,  that  as  there  are  inflammations  of 

the 


PRACTICE 

the  inteftines  without  flercoraceous  vomiting,  fo  I  have 
feea  inftances  of  flercoraceous  vomiting  without  in- 
flammation ;  and  there  is  therefore  no  ground  for  dif- 
tinguiihing  ileus  from  colic,  but  as  a  higher  degree  of 
the  fame  aftedlion. 

MCCCCXXXIX. 

The  fymptoms  of  the  colic,  and  the  diflc&ions  of 
bodies  dead  of  this  difeafe,  fhow  very  clearly,  that  it 
depends  upon  a  fpafmodic  conftricYion  of  a  part  of  the 
intcftines ;  and  that  this  therefore  is  to  be  confidered 
as  the  proximate  caufe  of  the  difeafe.  Infome  of  the 
difledions  of  perfons  dead  of  this  difeafe,  an  intus-luf- 
ception  has  been  remarked  to  have  happened;  but 
whether  this  be  conftantiy  the  cafe  in  all  the  appear- 
ances of  ileus,  is  not  certainly  determined. 
MCCCCXL. 

The  colic  has  commonly  been  confidered  as  being 
of  different  fpecies,  but  I  cannot  follow  the  writers  on 
this  fubjeci  in  the  diftindions  they  have  cftablifhed. 
So  far,  however,  as  a  difference  of  the  remote  caufe 
confbitutes  a  difference  of  fpecies,  a  diflindion  may  per- 
haps be  adaiiited;  and  acco»ding]y  in  my  Nofology  I 
have  marked  feven  different  fpecies  :  but  I  am  well 
perfuaded,  that  in  all  thefe  different  fpecies  the  prox- 
imate caufe  is  the  fame,  that  is,  a  fpafmodic  conftridion 
of  a  part  of  the  inteftines;  and  confequently,  that  in 
all  thefe  cafes  the  indication  of  cure  is  the  fame,  that 
is,  to  remove  the  conftrifltion  mentioned.  Even  in 
the  feveral  fpecies  named  Stercorea^  Callofa^  and  Cal- 
culofd)  in  which  the  difeafe  depends  upon  an  obilruc- 
tipn  of  intefline,  I  am  perfuaded  that  thefe  pbftrttdtr- 
ons  do  not  produce  the  fymptoms  of  colic,  excepting 
in  fo  far  as  they  produce  fpafmodic  conftriclions  of  the 
inteftines ;  and  therefore,  that  the  means  of  cure  in 
thefe  cafes,  fo  far  as  they  admit  cf  cure,  muft  be  ob- 
tained by  the  fame  means  which  the  general  indica- 
tion above  mentioned  fudged s. 

MCCCCXLI. 


O  F    P  H  Y  S  I  C.  215 

MCCCGXLI. 

The  cure,  then,  of  the  colic  univerfally,  is  to  be  ob- 
tained by  removing  the  fpafmodic  conftridions  of  the 
inteftmes ;  and  the  remedies  fuited  to  this  purpofc 
may  be  referred  to  three  general  heads  : 

1.  The  taking  off  the  fpafm  by  various  amifpafmo- 
dic  powers. 

2.  The  exciting  the  action  of  the  inteilines  by  pur- 
gatives. 

3.  The  employing  mechanical  dilatation. 

MCCCCXLII. 

Before  entering  upon  a  more  particular  account  of 
thefe  remedies,  it  will  be  proper  to  obferve,  that  in  all 
cafes  of  violent  colic,  it  is  advifabie  to  pradlife  blood- 
letting ;  but  as  it  may  be  ufeful  in  obviating  the  in- 
flammation which  is  commonly  to  be  apprehended, 
and  even  as  it  may  be  a  means  of  relaxing  the  fpafra 
of  the  inteftine.  This  remedy  may  perhaps  be  im- 
proper in  perfons  of  a  weak  and  lax  habit,  but  in  all 
perfons  of  tolerable  vigour  it  will  be  a  fafe  remedy  ; 
and  in  all  cafes  where  there  is  the  leafl  fufpicion  of 
an  inflammation  actually  coming  on,  it  will  be  abfo- 
lutely  neceflary.  Nay,  it  will  be  even  proper  to  re- 
peat it  perhaps  fever al  rimes,  if,  with  a  full  and  hard 
pulfe,  the  appearance  of  the  blood  drawn,  and  the  re- 
lief obtained  by  the  firft  bleeding,  fhall  authorife  fuch 
repetition. 

MCCCCXLIII. 

The  antifpafmodic  powers  that  may  be  employed, 
are,  the  application  of  heat  in  a  dry  or  humid  form, 
the  application  of  blifters,  the  ufe  of  opium,  and  the 
ufe  of  mild  oils. 

The  application  of  heat,  in  a  dry  form,  has  been 
employed  by  applying  to  the  belly  of  the  patient  a 
living  animal,  or  bladders  filled  with  warm  water,  or 
bags  of  fubilances  which  long  retain  their  heat;  and 
all  thefe  have  fometimes  been  applied  with  fuccefs  ; 

but 


PRACTICE 

but  none  of  them  feem  to  me  fo  powerful  as  the  appli- 
cation of  heat  in  a  humid  form. 

This  may  be  employed  either  by  the  immerfion  of 
a  great  part  of  the  body  in  warm,  water,  or  by  fo- 
menting the  belly  with  cloths  wrung  out  of  hot  water. 
The  immerfion  has  advantages  from  the  application  of 
it  to  a  greater  part  of  the  body,  and  particularly  to 
the  lower  extremities:  but  immerfion  cannot  always 
be  conveniently  practifed,  and  fomentation  may  have 
the  advantage  of  being  longer  continued  ;  and  it  may 
have  nearly  all  the  benefit  of  immerfion,  if  it  be  at 
the  fame  time  applied  both  to  the  belly  and  to  the 
lower  extremities. 

MCCCCXLIV. 

From  confidering  that  the  teguments  of  the  lower 
belly  have  fuch  a  connection  with  the  interlines,  as  at 
the  fame  time  to  be  affected  with  fpafmodic  contrac- 
tions, we  perceive  that  bliflers  applied  to  the  belly 
may  have  the  effect  of  taking  off  the  fpafms  both  from 
the  mufcles  of  th£  belly  and  from  the  interlines ;  and 
accordingly,  bliftering  has  often  been  employed  in  the 
colic  with  advantage.  Analogous  to  this,  rubefaci- 
ents  applied  to  the  belly  have  been  frequently  found 
ufeful. 

MCCCCXLV. 

The  ufe  of  opium  in  colic  may  feem  to  be  an  ambi- 
guous remedy.  Very  certainly  it  may  for  fome  time 
relieve  the  pain,  which  is  often  fo  violent  and  urgent, 
that  it  is  difficult  to  abflain  from  the  ufe  of  fuch  a  re- 
medy. At  the  fame  time,  the  ufe  of  opium  retards 
or  fufpcnds  the  periftaltic  motion  fo  much,  as  to  allow 
the  interlines  to  fall  into  conflrictions ;  and  may  there- 
fore, while  it  relieves  the  pain,  render  the  caufe  of 
the  difeafe  more  obflinate.  Oa  this  account,  and 
further  as  opium  prevents  the  operation  of  purga- 
tives fo  often  neceifary  in  this  difeafe,  many  practiti- 
oners are  averfe  to  the  ufe  of  it,  and  fome  entirely  re- 


O  F    P  H  Y  S  I  C.  217 

jedt  the  ufe  of  it  as  hurtful.  There  are,  however,  o- 
thers  who  think  they  can  employ  opium  in  this  difcafe 
with  much  advantage. 

In  all  cafes  where  the  colio  comes  on  without  any 
previous  cofliveneis,  and  ai  ifes  from  coldj  from  pafli- 
ons  of  the  mind,  or  other  caufes  which  operate  efpeui- 
ally  on  the  nervous  fyftem,  opium  proves  a  fafc  and 
certain  remedy  >  but  in  cafes  which  have  been  preced- 
ed by  long  coitivenefs,  or  where  the  colic,  though  not 
preceded  by  coflivenefs,  has  however  continued  for 
fome  days  without  a  ilool,  fo  that  a  flag-nation  offices 
in  the  colon  is  to  be  fufpeded,  the  ufe  of  opium  is  of 
doubtful  effect.  In  ftich  cafes,  unlefs  a  itool  has  been 
firit  procured  by  medicine,  opium  cannot  be  employ- 
ed but  with  fome  hazard  ot  aggravating  the  difeafe. 
However,  even  in  thofe  circumitances  of  cofliveneis, 
when,  without  inflammation,  the  violence  of  the  fpafra 
is  to  be  fufpecled,  when  vomiting  prevents  the  exhibi- 
tion of  purgatives,  and  when  with  all  this  the  pain  is 
extremely  urgent,  opium  is  to  be  employed,  not  only 
as  an  anodyne,  but  alfo  as  an  antifpaimodic,  neceiTary 
to  favour  the  operation  of  purgatives ;  and  may  befo 
employed,  when,  either  at  the  fame  time  with  the  opi- 
ate, or  not  long  after  it,  a  purgative  can  be  exhibited. 

Is  the  hyoiciamus,  as  often  ihowing,  along  with  its 
narcotic,  a  purgative  quality,  better  iuited  to  this  dif- 
eafe than  opium  ? 

MCCCCXLVI. 

It  is  feemingly  on  good  grounds  that  feveral  prac- 
titioners have  recommended  the  large  ufe  of  mild  oils 
in  this  difeafe,  both  as  antifpafmodics  and  as  laxatives  ; 
and,  where  the  palate  and  (tornach  could  admit  them, 
I  have  found  them  very  ufeful.  But  as  there  are  few 
Scottiih  itomachs  that  can  admit  a  large  ufe  of  oils,  I 
have  had  few  opportunities  of  employing  them. 
MCCCCXLVII. 

The  fecond  fet  of  remedies  adapted  to  the  cure  of 

VOL.  II.  E  e  colic, 


2i8  P  R  A  C  T  I  C  E 

colic,  are  purgatives ;  which,  by  exciting  the  adion 
of  the  intcftines,  either  above  or  below  the  cbftruftcd 
place,  may  remove  the  conftridion  ;  and  therefore 
thefe  purgatives  may  be  given  either  by  the  mouth, 
or  thrown  by  glyiter  into  the  anus.  As  the  difeale  is 
often  feated  in  the  great  guts ;  as  glyfters,  by  having  a 
more  fudden  operation,  may  give  more  immediate  re- 
lief; and  as  purgatives  given  by  the  mouth  are  ready 
to  be  rejected  by  vomiting ;  fo  it  is  common,  and  in- 
deed proper,  to  attempt  curing  the  colic  in  the  firft 
place  by  glyfters.  Thefe  may  at  firft  be  of  the  mildeft 
kind,  confiding  of  a  large  bulk  of  water,  with  fome 
quantity  of  a  mild  oil;  and  fuch  are  fometimes  fuffi- 
cientiy  efficacious  :  however,  they  are  not  always  fo ; 
and  it  is  commonly  neceflary  to  render  them  more 
powerfully  ftimulant  by  the  addition  of  neutral  falts, 
of  which  the  moft  powerful  is  the  common  or  marine 
fait.  If  thefe  faline  glyfters,  as  fometimes  happens,  are 
rendered  again  too  quickly,  and  on  thisaccountor  other- 
wife  are  found  ineffectual,  it  may  be  proper,  inftead 
of  thefe  falts,  to  add  to  the  glyfters  an  infufion  of  fen- 
na,  or  of  fome  other  purgative  that  can  be  extracted 
by  water.  The  antimonial  wine*  may  be  fometimes 
employed  in  glyfters  with  advantage.  Hardly  any 
glyfters  are  more  effectual  than  thofe  made  of  turpen- 
tine properly  §  prepared.  When  all  other  injections 

are 

*   Tartar  Emetic  is  furer  than  the  antimonial  wine  ;  bat   it   is  a 
very  violent  remedy,  and  ought  to  be  ufed  with  caution  even  in  cly- 
fters.      Five  or  fix  grains  is  the  ufual  quantity  given  in  clyfters. 
§  The  proper  manner  of  preparing  turpentine  clyfters  is  as  follows : 
R.  Terebx  Venet.  3vi. 
V»tel.  Ov.  No.  ii. 

Ttre  in  mortario  marmorco  donee  pcnitus  folvetur 
Terebhuhina  ;  dein  addc  gradatiin, 
Aq.  font,  frigida,  ^ii. 
Huic  afFunde 


O  F     P  H  Y  S  I  C.  219 

are  found  ineffectual,  recourfe  is  to  be  had  to  the  in- 
jection of  tobacco-fmoke ;  and,  when  even  this  fails, 
recourfe  is  to  be  had  to  the  mechanical  dilatation  to 
be  mentioned  hereafter. 

MGGCCXLVIIL 

As  glyflers  often  fail  altogether  in  relieving  this 
difeafe,  and  as  even  when  they  give  feme  relief  they 
are  often  imperfedtin  producing  acompletecure;  foitis 
generally  proper,  and  often  necelTary,  to  attempt  a  more 
entireand  certaincure  bypurgatives  given  by  the  mouth. 
The  more  powerful  of  thefe,  or,  as  they  are  called*  the 
Draftic  Purgatives,  may  be  fometimes  neceffkiy  ;  but 
their  ufe  is  to  be  avoided,  both  becaufc  they  are  apt  to 
be  rejected  by  vomiting,  and  becaufe  when  they  do 
not  fucceed  in  removing  the  obftruclion  they  are  rea- 
dy to  induce  an  inflammation,  Upon  this  account  it 
is  ufual,  and  indeed,  proper,  at  lead  in  the  nrrt  place, 
to  employ  the  milder  and  lefs  inflammatory  purgatives. 
None  have  fucceeded  with  me  better  than  the  cryf- 
tals  of  tartar*,  becaufe  this  medicine  may  be  conve- 
niently given,  in  fmall  but  repeated  dofes,  to  aconfi- 
derable  quantity;  and  under  this  management  it  is 
the  purgative  lead  ready  to  be  rejected  by  vomiting, 
and  much  lefs  fo  than  the  other  neutral  falts.  If  a 
flronger  purgative  be  required,  jalap  §,  properly  pre- 

E  e  2  pared, 

Aq.  font,  tepid,  ibi. 
M.  f.  Enema,  ttatim  injiciend. 

If  the  turpentine  does  not  diflolve  fufficiently  with  the  yolks  of 
two  eggs,  a  third  may  be  added. 

*  Crytlals  of  tartar  may  be  given  in  dofes  of  two  drams  each,  re- 
peated every  two  hours  oroftener.  The  chief  objection  againfi:  the 
ufe  of  this  fait  is  its  difficult  foiution  in  water,  and  therefore  many 
practitioners  prefer  the  folubie  tartar,  or  the  Rochelfalt. 

§  The  Pulvis  Jalap,  comp.  of  the  Edinburgh  Pharmacopoeia  an- 
fwer*  in  general  very  well ;  but,  the  following  formula  is  lefs  liabTe 
to  be  rejected  by  the  vomiting  which  fo  frequently  accompanies  this 
difeafe. 

]$..  Refin.  Jalap  gr.  xii. 

Amygdal.  dulc.  decorticat.  No.  TI. 


220  PRACTICE 

pared,  is  lefs  offensive  to  the  palate,  and  fits  better 
upon  the  ftomach,  than  mofl  other  powerful  purga- 
tives. On  many  occafions  of  colic,  nothing  is  more 
effectually  purgative  than  a  large  d^fe  of  calomel*. 
Some  practitioners  have  attempted  to  remove  the  ob- 
frructions  of  the  inteftines  by  antimonial  emetics§  ex- 
hibited in  fmall  dofes  repeated  at  proper  intervals ; 
and  when  thefe  dofes  are  not  entirely  rejected  by  vo- 
miting, they  often  prove  effectual  purgatives. 

When  every  purgative  has  failed,  the  action  of  the 
inteftines  has   been  effectually  excited  by   throwing 
cold  water  on  the  lower  extremities. 
MCCCCXLIX. 

The  third  means  of  overcoming  the  fpafm  of  the  in- 
teftines in  this  difeafe,  is  by  employing  a  mechanical 
dilatation ;  and  it  has  been  frequently  fuppofed  that 
quickfilver,  given  in  large  quantity,  might  operate  in 
tliis  manner.  I  have  not,  however,  found  it  fucccfs- 
ful ;  and  the  theory  of  it  jjs  with  me  very  doubtful. 
Some  authors  Jtave  mentioned  the  ufeof  gold  and  fil- 
ver  pills,  or  balls,  fwallowed  down  ;  but  I  have  no  ex- 
perience of  fuch  practices,  and  I  cannot  fuppofe  them 
2  probable  means  of  relief. 

MCCCCL. 

Another  means  of  mechanical  dilatation,  and    a 

moi 


Sacch.  alb.  gi. 

Tere  in  mortario  marmoreo,  et  adde  gradatim, 

Aq.  Cinnamom.  fitnpl.  ^i* 

M.  f  hauft. 

Half  of  this  portion  may  be  given  at  once,  and  tbc  other  half  an  hour 
afterward. 

*  This  is  French  pra&ice,  but  it  is  dangerous.  It  has  however 
been  ferviceablc  in  many  cafes,  when  given  in  dofes  of  12  or  15 
grains,  or  even  a  fcruple  when  other  purgatives  have  failed. 

$  As  the  ftomach  (as  was  before  obferved)  is  very  imtable  in  this 
difeafe,  the  pra&itioner  will  find  confiderable  difficulty  in  managing 
antimonials.  It  is  better  to  avoid  them  altogether,  fpr  they  may 
do  much  mifchJef. 


OF       PHYSIC.  221 

more  probable  meafure,  is  by  injecting  a  larje  quan- 
tity of  warm  water  by  a  proper  fyringe,  which  may 
throw  it  with  fome  force,  and  in  a  continued  ft  ream, 
into  the  rectum.  Both  from  the  experiments  report- 
ed by  the  late  Mr.  De  Haen,  and  from  thcfc  I  myfeif 
have  had  occafionto  make,  1  judge  this  remedy  to  be 
one  of  the  moil  powerful  and  effectual*. 
MCCCCLI. 

I  have  now  mentioned  ail  the  fevcrrJ  mean;  that 
may  be  employed  for  the  cure  of  the  colic,  confidered 
as  a  genus  ;  but  before  I  quit  this  fubjecl,  it  may  be 
exped^d  that  I  fhould  take  notice  of  fome  of  the  fpe- 
cies  which  may  fcem  to  require  a  particular  confldera- 
tion.  In  this  view  it  may  be  expt&ed  that  I  fhould 
efpecuilly  take  notice  of  the  fpeci^s  named  the  Colic 
of  Poitou,  and  particularly  knov/n  in  England  by  the 
name  of  the  Devonshire  Colic. 

MCCCJLJI. 

This  fpecies  of  the  difeafe  is  certainly  a  peculiar 
one,  both  in  refpect  of  its  caufe  and  its  efft&s  ;  but, 
as  to  the  firft,  it  has  been  lately  fo  much  the  fubjecl: 
of  invefligation,  and  is  fo  well  afcertained  by  the 
learned  phyficians.  Sir  George  Baker  and  Dr.  Hardy, 
that  it  is  unneeellary  for  me  to  fay  any  thing  of  it 
here. 

With  refpecl  to  the  cure  of  it*,  fo  far  as  it  appears 


It  is  to  be  thrown  up,    by  means  of  a  lame    fyn'nje,    in  fu?^ 
quantises,  till  the  patient  begins  to    feel  a  ftnfe   of  uneafincf   f«-  n 
the  great  diftention  which  it  occasions.      Some  patients  haw  ! 
two  gallons  to  be  ir.jccted,  and  the  cafes  were 'attended  v.ith   iV 
den red  fuccefs. 

The  cafes  in  which  thefe  large  injecHcns  are  moft  nfeful,  nre  tlu-.^c 
in  which  hardened  fasces  are  accumulated  in  the  cohn.      The  wrA 
water  anfweris  two  intentions,  viz.  dilating  the  paffj^e,  and  f 
ing  the  fa?ces. 

§  In  the  early  (hges  of  this'difcafe,  the  be:ly  is  to  be  krpt  op;-n 
by  the  mildeft  laxatives,  and  a  milk  diet  ftriaiy 'uf.-J.  The-  fellow- 
ing  formula  anfwers  extremely  well  ; 


PRACTICE 

In  the  form  of  a  colic,  my  want  of  experience  concern* 
ing  it  does  not  allow  .me  to  fpeak  with  any  confidence 
on  the  fubject ;  but,  fo  far -as  I  can  learn  from  others, 
it  appears  to  me,  that  it  is  to  be  treated  by  all  the  fe~ 
veral  means  that  I  have  propofed  above  for  the  cure  of 
colic  in  general. 

How  far  the  peculiar  effeds  of  this  difeafe  are  to  be 
certainly  forcfeen  and  obviated,  I  have  not  properly 
learned  ;  and  I  muft  leave  the  matter  to  be  determin- 
ed by  thofe  who  have  hadfufficient  experience  in  it. 


C   K  A  P.     X. 

OF    THE     CHOLERA, 

MCCCCLIII. 

fN  this  difeafe,    a.  vomiting  and  purging  concurring 
together,  or  frequently  alternating  with  one  another, 
-:e  the  chief  fymptoms.      The  matter  rejecled  both 
upwards  and  downwards  appears  manifeftly  to  confift 
chiefly  of  bile. 

MCCCCLIV. 

From  this  lad  circumftance    I  conclude,    that  the 
difeafe  depends    upon   an    increafed  fecretion  of  the 
bile,  and  its  copious  effufion  into  the  alimentary  ca- 
nal •  and,   as   in  this  it  irritates  and  excites  the  mo- 
tions 

%  Mannsc. 
*  Ol.  olivar.  a  a  Ji. 

M.  f.  Linclus. 

TIiJs  quantity  is  a  proper  dofe,  and  it  may  be  repeated  every  day 
with  thirty  or  forty  drops  of  laudanum  at  bed-time.  If  the  fymp- 
toms, however,  do  not  abate,  vvs  may  (at  the  fame  time,)  give 
large  emollient  clyfters. 


OF    PHYSIC.  223 

tions  above  mentioned,  I  infer,  that  the  bile  thus  ef- 
fufed  in  larger  quantity  is  at  the  lame  time  alfo  of  a 
more  :ic.id  quality.  This  appears  like  wife  from  the 
violent  and  very  painful  gripings  that  attend  the  dif- 
eafe, and  which  we  can  impute  only  to  the  violent 
fpafmcdic  c.  mrncYions  of  the  inteftines  that  take  place 
here.  Thefe  ipafms  are  commonly  communicated  to 
the  abdominal  mufcles,  and  very  frequently  to  thofe 
cf  the  extremities. 

MCCCCLV. 

In  the  manner  now  defcribed,  the  difeafe  frequent- 
ly proceeds  wiih  great  violence,  till  the  ftrength  ot 
the  patient  is  greatly,  and  often  fuddenly  weakened  ; 
while  a  coldnefs  of  the  extremities,  cold  fweats,  and 
faintings,  coming  on,  an  end  is  put  to  the  patient's 
life,  L-me times  in  the  courfe  of  one  day.  In  other 
cafts  the  difeafe  is  lefs  violent,  continues  for  a  day  or 
two,  and  then  ceafes  by  degrees ;  though  fuch  reco- 
veries feldom  happen  without  the  affifiance  of  reme- 
dies. 

MCCCCLVI. 

The  attacks  of  this  difeafe  are  feldom  accompanied 
with  any  fymptoms  of  pyrexia  :  and  though,  during 
the  courfe  of  it,  both  the  pulfe  and  refpiration  are 
hurried  and  irregular,  yet  thefe  fymptoms  are  gene- 
rally fo  entirely  removed  by  the  remedies  that  quiet 
the  ipafmodic  affe&ions  peculiar  to  the  difeafe,  as  to 
leave  no  ground  for  fuppofing  that  it  fcad  been  accom- 
panied by  any  proper  pyrexia. 

MCCCCLVII. 

This  is  a  difeafe  attending  a  very  warm  ftate  of  the 
air ;  and  in  very  warm  climates,  it  may  perhaps  ap- 
pear at  any  time  of  the  year :  but  even  in  fuch  cli- 
mates it  is  mod  frequent  during  their  warmed  feafons  > 
*and  in  temperate  climates,  it  appears  only  in  the 
warm  feafons.  Dr.  Sydenham  confidercd  the  appear- 
ances of  this  difeafe  in  England  to  be  confined  to  the 

month 


224  PRACTICE 

month  of  Augud  ;  but  he  himfelf  obferved  it  to  ap- 
ptar  funietiii.es  towards  the  end  of  iuinmer,  when  the 
feafon  was  liiiu/l^lly  vvaim  ;  and  that,  in  proportion  to 
the  heat,  the  violence  of  the  difeafc  was  greater. — 
Otheis  have  obferved  that  it  appeared  more  early  in 
fummer,  and  always  fooner  or  later,  according  as  the 
great  heats  IOCIKT  or  later  fet  in. 

MCCCCLVIII. 

Fiom  all  thefe  circumftances,  it  is,  I  think,  very 
evident  that  this  difeafe  is  the  effect  of  a  warm  atrnof- 
phere,  producing  fome  change  in  the  flate  of  the  bile 
in  the  human  body  ;  and  the  change  may  confift,  ei- 
ther in  the  matter  of  the  bile  being  rendered  more 
acrid,  and  thereby  fitted  to  excite  a  more  copious  fe- 
cretk,n  ;  or,  in  the  faa:e  matter,  its  being  prepared  to 
pafsoifin  larger  quantity  than  ufual. 

MJCCCLIX. 

It  has  been  remarked,  that  in  warm  climates  and 
feafons,  after  extremely  hot  and  dry  weather,  a  fall  of 
rain  cooling  the  atmofphcre  feems  cfpecially  to  bring 
on  this  difeafe  ;  and  it  is  vciy  probable  that  an  ob- 
ilvucled  penpiration  may  have  a!f)  a  fnare  in  this, 
though  it  is  alfo  certain  that  the  difeafe  does  appear 
when  no  change  in  the  temperature  of  the  ah  3  nor  any 
application  oi  cold,  has  been  obferved. 

MCCCCLX. 

It  is  poflible,  that,  in  fome  cafes,  the  heat  of  the 
feafon  may  ^ive  only  a  predifpoiition,  and  that  the 
difeafe  may  be  excited  by  certain  ingefta  or  other  cauf- 
es  ;  but  it  is  equally  certain,  that  the  difeafe  has  occur- 
red  without  any  pieviuus  change  or  error,  either  in 
diet,  or  in  the  manner  c,f  life,  that  could  be  obferved.' 

MCCCCLXi. 

The  Nofologifts  have  conilitutcd  a  Genus  '*nacr 
tl.e  title  of  Cholera,  and  under  this  have  arranged  as 
fpecies,  every  affection  in  which  a  vomiting  ancl  purg- 
ing of  any  kind  happened  to  concur.  In  many  of 

thefe 


OF     PHYSIC.  225 

thefe  fpecies,  however,  the  matter  evacuated  is  net  bi- 
lious ;  nor  does  the  evacuation  proceed  from  any 
caufe  in  the  (late  of  the  atmofphere.  Further,  in  ma- 
ny of  thefe  fpecies  alib,  the  vomiting  which  occurs  is 
not  an  efll-ntial,  but  merely  an  accidental,  fyrnptom 
from  the  particular  violence  of  the  difeafe.  The  ap- 
pellation <f  Cholera  therefore  fhouid,  ia  my  opinion^ 
be  confined  to  the  difeafe  I  have  d.fcribed  above  ; 
which  by  its  peculiar  caufe,  and  perhaps  alfo  by  its 
fymptoms,  is  very  different  from  all  the  other  fpecies 
that  have  been  ailbciated  with  it.  I  believe  that  all 
the  o'her  fpecies  arranged  under  the  title  of  Cho- 
lera by  Sauvages  or  Sigar,  may  be  properly  enough 
referred  to  the  genus  of  Diarrhoea  ;  which  we  are  to 
treat  of  in  the  nexUphapter. 

The  diftinciion  I  have  endeavoured  to  eftabliih  be- 
tween the  proper  Cholera,  and  the  other  difeafes  that 
have  fornetimes  got  the  fame  appellation,  will,  as  I 
judge,  fuperfede  the  queftion.,  Whether  the  Cholera, 
in  temperate  climates,  happens  at  any  other  feafoh 
than  that  above  afligned  ? 

MCCCCLXIL 

In  the  cafe  of  a  genuine  cholera,  the  cure  of  it  has 
been  long  eftabiiflicd  by  experience. 

In  the  beginning  of  the  difeafe,  the  evacuation  of 
the  redundant  bile  is  to  be  favoured  by  the  plentiful 
exhibition  of  mild  diluents*,  both  given  by  the  mouth, 
and  injected  by  the  anus  ;  and  all  evacuant  medicines, 
employed  in  either  way,  are  not  only  fuperfiuous,  but 
commonly  hurtful. 

MCCCCLX11L 

When  the  redundant  bile  appears  to  be  fufficiently 
warned  out,  and  even  before  that,  if  the  fpafmodic  af- 

VOL.   II.  F  f  fedions 

f  Thin  rice-gruel  is  as  proper  a  mild  diluent  as  any  we  can  ufe  : 
as  is  rtlio  water  in  which  a  cruft  of  bread  is  boiled.  A  very  fmall 
quantity  of  port  wine  may  be  added  to  tliefe  diluents  if  the  puJfe  K- 
iniali  or  weak. 


226  PR  AC  T  I  C  E 

feclroirs  of  the  alimentary  canal  become  very  violeniy 
and  are  communicated  in  a  considerable  degree  to  other 
pa.ta  of  the  body,  or  when  a  dangerous  debility  feems 
to  be  induced,  the  irritation  is  to  be  immediately 
obviated  oy  opiates  in  iufficiently  large  dofes,  but 
in  fniall  bulk,  and  given  either  by  the  mouth,  or  by 
glvikr*. 

MCCCCLXIV. 

'Though  the  patient  be  in  this  manner  relieved,  it 
frequently  happens,  that  when  the  operation  of  the  opi- 
um is  over,  the  dileafe  mows  a  tendency  to  return  5 
and,  for  at  lead  fome  days  afrer  the  firft  attack,  the  ir- 
ritability of  the  inteftines,  and  their  difpolition  to  fall 
into  painful  fpafmodic  contractions,  feem  to  continue. 
In  this  iituation,the  repetition  of  the  opiates,  for  perhaps 
ieveral  days,  may  come  to  be  necerTary  ;  and  as  the 
debility  commonly  induced  by  the  difeafe  favours  the 
difpoiitron  to  fpafmodic  affections,  it  is  often  ufeful  and 
neceifary,  together  with  the  opiates,  to  employ  the  to- 
nic powers  of  the  Peruvian  bark§. 

C  H  A  P. 

*   A  pill  confiding  of  a   grain  of  opium  may  be  given  every  two' 
hours,    and  if   it  does  not  relieve  the   fymptoms   after   the  third  OF 
fourth  repetition,  we  may  injeA  the  follbwing  glyiler  : 
§,.  Decoa.  Hord.  |x. 
Tin  it.  Thebaic.  3ii. 
M.  f.  Enema. 

This  clyfter  may  be  repeated  twice,  or  thrice  if  there  be  occafion. 
§   The  bark  in  thefe  cafes,  is  ofteii  fuccefsfully  given  along  with 
rhubarb,  as  in  the  following  formula  : 

P..  Pulv.  Cort.  Peruv,  Jfs. 
Rad,  Khei.  ^i. 

M.  f.  lulv.  in  part.  JEqual.  xii.  dividend. 

One  of  thefe  powers   may   he  given  thi'ee   times  a  day  with  » 
glafsof  port  \vi;:-. 


OF    P.H  Y  S  I  C.  227 

C    II     A     P.        XI. 


OF  DTARRHCEA  OH   LOOSEME^S,  ' 


MGCCCLXV. 

I^HIS  difeafe  confifls  in  evacuation  by  itocl,  more 
frequent  and  of  more  liquid  matter  drin  ufual. 
This  leading  and  characteriftic  fymptom  is  io  diverfi- 
iied  in  its  degree,  in  its  cauies,  and  in  the  variety  of 
matter  evacuated,  that  it  is  al-noil  impolitic  io  give 
any  general  hiftory  of  the  difeafe. 

'MCCCGLXVI. 

It  is  to  be  diflinguifhed  from  dy  fernery,  by  not  be- 
ing  contagious  ;  by  being  generally  without  fever  ; 
and  by  being  with  the  evacuation  of  the  natural  ex- 
crements, which  are,  at  lead  for  fometime,  retained 
in  dyfentery.  The  two  difeafes  have  been  commonly 
uiftinguifhed  by  the  gripings  being  more  violent  in 
the  dyfentery  ;  and  they  are  commonly  leis  violent 
and  leis  frequent  in  diarrhoea  :  but  as  they  frequently 
do  occur  in  this  alfo,  and  ibmetimes  to  a  confiderable 
degree,  fo  they  do  not  afford  any  proper  diiiiiittion*. 

MCCCCLXVJI. 

A  diarrhoea  is  to  be  difting  uiflied  from  cholera 
y  by  the  difference  of  their  caufes  ;  which,  in 
cholera,  is  of  one  peculiar  kind  ;  but  in  diarrhoea  is 
prodigioufly  diverfified,  as  we  fliall  fee  pvefcrntiy.  It 
has  been  common  to  dtftinguifh  cholera  by  tlie  eva- 
cuation downwards  being  of  bilious  matter,  and  by 
this  being  always  accompanied  with  a  v.  nv'ting  of  the 
lame  kind  ;  but  it  does  not  univerfally  apply,  '^  a  tliar- 

Ff2 


*  TencfmiTs  is  a  el  ifi  ing  mfhlng  fymptom  of  dyfeiitfry,   but  it  is 
fotnetimcs  piefent    in    diarrhoea   alfo;   efpecidliy    tivofe 
which  proceed  from  acjTo  cr  putrid  fubftances  in  the  ttUefline*. 


228  PRACTICE 

rhoea  is  fometimes  attended  with  vomiting,  and  even 
of  biiious  matter. 

MCCCCLXVIII. 

The  difeafe  of  diarrhoea,  thus  diftinguifhed,  is  very 
greatly  diveriified  ;  hut  in  all  cafes,  the  frequency  of 
ilobls  is  to  be  impured  to  a  preternatural  increafe  of  the 
periftaitic  motion  in  the  whole,  or  at  kaft  in  a  confi- 
derable  portion,  of  the  inteftinal  canal.  This  increaf- 
ed action  is  in  different  degrees,  is  often  convulfive  and 
fpafmodicy  and  .at  any  rate  is  a  motus  abnormis :  for 
which  reafon,  in  the  Methodical  Nofblogy,  I  have  re- 
ferred it  to  the  order  of  Spafmi>  and  accordingly  treat 
of  it  in  this  place. 

MCCCCLX1X. 

Upon  the  fame  ground,  as  I  confider  the  difeafe 
named  Lientcry  to  be  an  increafed  perifiaitic  motion 
over  the  whole  of  the  inteflinal  canal,  arifing  from  a 
peculiar  irritability,  I  have  confidered  it  us  merely  a 
j'pecies  of  diarrhoea..  The  idea  of  a  laxity  of  the in- 
tciiinal  canal  being  the  caufe  either  of  lientcry,  or 
other  fpecies  of  diarrhoea,  appears  to  me  without  foun- 
dation, except  in  the  fmgle  cafe  of  frequent  liquid 
ilools  from  a  palfy  of  the  fphinfter  ani. 
MCCCCLXX. 

The  increafed  action  of  the  periftaitic  motion,  I  con- 
fider as  always  the  chief  part  of  the  proximate  caufe 
of  diarrhoea :  but  the  difeafe  is  further,  and  indeed 
chiefly,  diveriificd  by  the  different  caufes  of  this  in- 
creafed a&ion  y  which  we  are  now  to  inquire  into. 
MCGGCLXXI. 

The  fever.il  caufes  of  the  increafed  aclion  of  the  in- 
teftiues  may  beTcferred,  I  think,  in  the  firil  place,  to 
two  general  heads. 

Thcjzr/t  is,  of  the  difeafes  of  certain  parts  of  the 
.body  which,  either  from  a  confent  of  the  interlines 
with  thefe  parts,  or  from  the  relation  which  the  iiuef- 
tines  have  to  the  whole  fyftcm,  occafion  an  increafed 

action 


OF    PHYSIC.  229 

action  in  the  inteftiries,  without  the  transference  of 
any  ftimulflnt  matter  from  the  primary  difeaied  pare 
to  them. 

The  fee on d  head  of  the  caufes  of  the  increafed  ac- 
tion of  the  interlines  is  the  ilimali  of  various  kinds, 
which  are  applied  directly  to  the  inteftines  tbemlelvcs. 
MCCCCLXXil. 

That  affections  of  other  parts  of  the  fyflem  may 
afFecl:  the  inteftines  without  the  transference  or  ap- 
plication of  any  ftimulant  matter,  we  learn  from  hence 
that  the  paffions  of  the  mind  do  in  fome  perfons  excite 
diarrhoea. 

MCCCCLXXI1L 

That  difeafes  in  other  parts  may  in  like  manner  af- 
'fecl  the  inteftines,  appears  from  the  dentition  of  in- 
fants frequently  exciting  diarrhoea.  I  be'ieve  that  the 
gout  often  affords  another  inftince  of  the  fame  kind  ; 
and  probably  there  are  others  aifo,  though  not  well 
afceruined. 

MCCCCLXXIV. 

The  flimuli  (MCCCCJLXXI.)  which  may  be  applied 
to  the  inteftines  are  of  very  various  kinds  j  and  are  ei- 
ther, 

1.  Matters  introduced  by  the  mouth. 

2.  Matters  poured  into  the  inteftines  by  the  feveral 
excretories  opening  into  them. 

3.  Matters  poured  f:orn  certain  preter-natural  open- 
ings made  into  them  in  certain  difeafes. 

MCCCCLXXV, 

Of  thole  (MCCCCLXXIV,  i.)  introduced  bv  t!;~ 
mouth,  the  fir  ft  to  be  mentioned  are  the  aliments 
commonly  taken  in.  Too  great  a  quantity  oft' 
taken  in,  often  prevents  their  due  digeflion  in  the  flc?- 
mach  ;  and  by  being  thus  fent  in  their  crude,  and  'pro- 
bably acrid,  Itate  to  the  inteftines,  they  frequently  ex- 
cite diarrhoea. 

The  fame  aliments,  though  in  proper  quantity, 

ha 


PRACTICE 

having  too  great  a  proportion,  as  frequently  happ; 
of  faline  or  iaccharine  matter  along  with  them,  prove 
ftimalant  to  the  int:f!ines,  and  excite  diarrhoea. 
•  Bat  our  aliments  prove  efpecially  the  caufes  of  di- 
arrhoea, according  as  they,  from  their  own  nature,  or 
from  the  weakneis  of  the  ilomach,  are  difpofed  to  un-- 
clergo  an  undue  degree  of  fermentation  there,  and 
thereby  become  (liraulant  to  the  inteilines.  Thus 
acefcent  aliments  are  ready  to  produce  diarrhoea  ;  but 
whether  from  their  having  any  direclly  purgative  qua- 
lity, or  only  as  mixed  in  an  over  proportion  with  the 
bile,  is  not  well  determined. 

MCCCCLXXVI, 

Not  only  the  acefcent,  but  aJfo  the  putrefcent  dif- 
poiiiionof  the  aliments,  feems  to  occafion  a  diarrhoea; 
and  it  appears  that  even  the  efiluvia  of  putrid  bodies, 
taken  in  any  way  in  large  quantity,  have  the  fame  cf- 


Are  oils  or  fats,  taken  in  as  a  part  of  our  aliments, 
ever  the  caufe  of  diarrhoea  ?  and  if  fo,  in  what  manner 
do  they  operate*  ? 

MGCCCLXXVII. 

The  other  matters  introduced  by  the  mouth,  which 
may  be  caufes  of  diarrhoea,  are  thofe  thrown  in  either 
as  medicines,  or  poifons  that  have  the  faculty  of  Simu- 
lating the  alimentary  canal.  Thus,  in  the  lift  of  the 
Materia  Medica,  we  have  a  long  catalogue  of  thofe 
named  purgatives;  and  in  theliit  of  puiions,  we  have 
many  pofieffed  of  the  fame  quality.  The  former, 
j'iven  in  a  certain  quantity,  occaiion  a  temporary  di- 
anhcEj  ;  and  given  in  very  large  dofes,  may  occafion 
it  in  excefs,  and  continue  it  longer  than  uiual,  produ- 
cing that  fpccies  of  diarrhoea  named  a  Hypercatharlis. 

MCCCCLXXVilL 

*   Rancid  o3s  and  fats  ccrtaJaly  irsriutc   t!ie  iateitines;  anJ  m;jy 
r.  ire  pro-dace 


6  F     P  H  Y  S  I  C.  231 

MCCCCLXXVIII. 

The  matters  (MCCCCLXXIV,  2.)  poured  into  the  cavi- 
ty of  the  inteftines  from  the  excretories  opening  into 
them,  and  which  may  occafion  diarrhoea,  are  either 
thofe  from  the  pancreatic  or  biliary  duel,  or  thofe 
from  the  excretories  in  the  coats  of  the  inteftines 
themfelves. 

MCCCCLXXIX. 

What  changes  may  happen  in  the  pancreatic  juice/ 
I  do  not  exadly  know ;  but  I  fuppofe  that  an  acrid 
fluid  may  iflue  from  the  pancreas,  even  while  ftiil  en- 
tire in  its  ftruchire  ;  but  more  efpecially  when  it  is  in  a 
fupporatcd,  fcirrhous,  or  cancerous  ftate,  that  a  very 
acrid  matter  may  be  poured  out  by  the  pancreatic 
duel:,  and  occafion  diarrhoea. 

MCCCCLXXX. 

We  know  well,  that  from  the  biliary  duel:  the  bile 
may  be  poured  out  in  greater  quantity  than  ufual;  and 
there  is  little  doubt  of  its  being  alfo  fometimes  pour- 
ed out  of  a  more  than  ordinary  quality.  It  is  very 
probable,  that  in  both  ways  the  bile  is  frequently  s 
caufe  of  diarrhoea. 

Though  I  have  faid  above  that  diarrhoea  may  be 
commonly  d  1  fling ui /lied  from  cholera  I  mult  admit 
here,  that  as  the  caufes  producing  that  Hate  of  the 
bile  which  occafions  cholera,  may  occur  in  all  the  dif- 
ferent poilible  degrees  offeree,  fo  as,  on  one  occasion* 
to  produce  the  mod  violent  and  diftirictJy  marked 
cholera  ;  but,  upon  another,  to  produce  only  the  gen- 
tled diarrhoea  :  which,  however,  will  be  the  fame  dif- 
eafe,  only  varying  in  degree  :  So  I  think  it  probable^ 
that  in  warm  climates,  and  in  warm  feafons,  a  diar- 
rhoea bih  of  a  of  this  kind  may  frequently  occur,  not  to 
be  always  certainly  diitinguifhed  from  cholera. 

However  this  may  be,  it  is  fufficiently  probable, 
that,  in  fome  cafes,  the  bile,  without  having  been  act- 
ed upon  by  the  heat  of  the  climate  or  feafon,  may  be 

redundant 


332  PRACTICE 

redundant  and  acrid,  and  prove  therefore  a  particular 
caufe  of  diarrhoea. 

MCCCCLXXXI. 

Bcfide  bile  from  the  feveral  canfes  and  in  the  con- 
ditions mentioned,  the  biliary  duel:  may  pour  out  pus, 
or  other  matter  from  abfcefles  in  the  liver,  which  may 
be  the  caufe  of  diarrhoea. 

Practical  writers  take  notice  of  a  diarrhoea  wherein 
a  thin  and  bloody  liquid  is  difchargecl ;  which  they 
fuppofe  to  have  proceeded  from  the  liver,  and  have 
therefore  given  the  difeafe  the  name  of  Hepatirrhoea  : 
but  we  have  not  met  with  any  initance  of  this  kind ; 
and  therefore  cannot  properly  fay  any  thing  concern- 
ing it. 

MCCCCLXXXir. 

A  fecond  fet  of  excretories,  from  which  matter  is 
poured  into  the  cavity  of  the  interlines,  are  thofe 
from  the  coats  of  the  intcflines  themfelves  ;  and  are  ei- 
ther the  exhalants  proceeding  directly  from  the  extre- 
mities of  arteries,  or  the  excretories  from  the  mucous 
follicles :  and  both  thefe  fources  occur  in  prodigious 
number  over  the  internal  furface  of  the  whole  intend- 
nal  canal.  It  is  probable  that  it  is  chiefly  the  effufion 
from  thefe  fources  which,  in  m-jfl  inflances,  gives  the 
matter  of  the  liquid  (tools  occurring  in  diarrhoea. 
MCCCCLXXX11I. 

The  matter  from  both  fources  may  be  poured  out 
in  larger  quantity  than  ufual,  merely  by  the  increafed 
action  of  the  inteftines,  whether  that  be  excited  by 
the  paflions  of  the  mind  (MCCCCXXII.)  by  difeafes  in 
other  parts  of  the  fyflem  (MCCCCLXXI,  i.)  or  by  the 
various  ftimulants  mentioned  MCCCCLXXV.  and  follow- 
ing; or  the  quantity  of  matt;  r  poured  out  may  be  in- 
creafed, not  ib  much  by  the  increafed  action  of  the  in- 
teftines,  as  by  an  increafed  afflux  of  fluids  from  other 
parts  of  the  fyflem. 

Thus,  cold  applied  to  the  furface  of  the  body,  and 

fupprefling 


OF       PHYSIC;  233 

fuppreffing    perfpiration,    may  determine   a    greater 
quantity  of  fluids  to  the  intettines. 

Thus,  in  the  ifchuria  renatis^  the  urine  taken  into 
the  blood-veflels  is  fometimes  determined  to  pafs  off 
again  by  the  interlines. 

In  like  manner,  pus  or  fertim  may  be  abfbrbed  from 
the  cavities  in  which  they  have  been  ftagnant,  and 
be  again  poured  out  into  the  inteftines,  as  frequently 
happens,  in  particular  with  refpett  to  the  water  of 
dropiies. 

MCCCCLXXXIV. 

It  is  to  be  obferved  here,  tbat  a  diarrhoea  may  be 
excited  not  only  by  a  copious  afflux  of  fluids  from 
other  parts  of  the  iyftem,  but  likewife  by  the  mere 
determination  of  various  acrid  matters  from  the  mafs  of 
blood  into  the  cavity  of  the  interlines.  Thus  it  is  fup- 
pofed  that  the  morbific  matter  of  fevers  is  fometimes 
thrown  out  into  the  cavity  of  the  interlines,  and 
gives  a  critical  diarrhcea  :  and  whether  I  do  or  do  not 
admit  the  doctrine  of  critical  evacuations,  I  think  it 
is  probable  that  the  morbific  matter  of  the  exanthe- 
mata is  frequently  thrown  upon  the  inteflines,  and 
occasions  diarrhoea. 

MCCGGLXXXV. 

It  is  to  me  further  probable,  that  the  putrefcent 
matter  diffufed  in  the  mafs  of  blood  in  putrid  difeafes? 
is  frequently  poured  out  by  the  exhalants  into  the  in- 
teftines,  and  proves  there  the  caufe,  at  lead  in  part,  of 
the  diarrhcea  fo  commonly  attended  with  thefe  dif- 
eafes. 

MCGCCLXXXVL 

Upon  this  fubjjecl  of  the  matters  poured  into  the  ca- 
vity of  the  interlines,  I  have  chiefly  confidered  them 
as  poured  out  in  unufual  quantity,  but  it  is  probable 
that,  for  the  mod  part,  they  are  alfo  changed  in  their 
quality,  and  become  of  a  more  acrid  and  liimulantna- 

VOL.  II.  G  g  ture; 


PRACTICE 

tuve  ;   upon  which  account  efpecially  it  is  that  the/ 
excite,  or  at  leuft  increafe,  a  diarrhoea. 
MCCCCLXXXVIL 

How  far,  and  in  what  manner,  the  exhalant  fluid 
may  be  changed  in  its  nature  and  quality,  we  do  not 
certainly  know  :  but  with  refpecl  to  the  fluid  from 
the  mucous  excretories,  we  know,  that,  when  poured 
out  in  unufual  quantity,  it  is  commonly,  at  the  fame 
time,  in  a  more  liquid  and  acrid  form  ;  and  may  prove, 
therefore,  confiderably  irritating, 

MCCCCLXXXVIII. 

Though  the  copious  efFulion  of  a  more  liquid  and 
acrid  matter  from  the  mucous  excretories,  be  proba- 
bly owing  to  the  matter  being  poured  out  immediate- 
ly as  it  is  fecreted  from  the  blood  into  the  mucous  fol- 
licles, without  being  allowed  to  ilagnate  in  the  latter, 
fo  as  to  acquire  that  milder  quality  and  thicker  con- 
fidence we  commonly  find  in  the  mucus  in  its  natural 
ftate;  and  although  we  might  fuppofe  that  the  excre- 
tions of  a  thin  and  acrid  fluid  mould  always  be  the  ef- 
fect of  every  determination  to  the  mucous  follicles, 
and  of  every  flimulant  applied  to  them  :  yet  it  is  cer- 
tain, that  the  reverfe  is  fometimes  the  cafe ;  and  that-, 
from  the  mucous  follicles,  there  is  frequently  an  in- 
creafed  excretion  of  a  mucus,  which  appears  in  its 
proper  form  of  a  mild  vifcid,  and  thickim  matter. 
This  commonly  occurs  in  the  cafe  of  dyfentery  ;  and 
it  has  been  obferved  to  give  a  fpecies  of  diarrhoea, 
which  has  been  properly  named  the  Diarrhoea  Mucvfa* 
MCCCCLXXXIX. 

A  third  fotirce  of  matter  poured  into  the  cavity  of 
the  interlines,  and  occaiioning  diarrhoea  (MCCCC- 
LXXIV,  3.)  is  from  thole  preternatural  openings  pro- 
duced by  diieafes  in  the  interlines  or  neighbouring 
parts.  Thus  the  blood-vefTels  on  the  internal  furface 
of  the  mteftines  may  be  opened  by  erofion,  rupture, 
or  anaflomofis,  and  pour  into  the  cavity  their  blood, 

which, 


OF    PHYSIC.  235 

•which,  either  by  its  quantity  or  by  its  acrimony,  whe- 
ther inherent,  or  acquired  by  Itagnation,  may  fome. 
times  give  a  diarrhoea  evacuating  bloody  matter.  This 
is  what  I  think  happens  in  that  difeafe  which  has 
called  the  Melcena  or  Morbus  Niger. 
MCCCCXC. 

Another  preternatural  fource  of  matter  poured  in- 
to the  cavity  of  the  inteitines,  is  the  rupture  of  abfcef- 
fes  feated  either  in  the  coats  of  the  interlines  them- 
felves,  or  in  any  of  the  contiguous  vilcera,  which,  du- 
ring an  inflamed  flate,  had  formed  an  adhefipn  with 
fome  part  of  the  interlines.  The  matter  thus  poured 
into  their  cavity  may  be  various  ;  purulent,  or  fanious, 
or  both  together,  mixed  at  the  fame  time  with  more 
or  lefs  of  blood  ;  and  in  each  of  thefe  ftates  may  be  a 
caufe  of  diarrhoea. 

MCCCCXCI. 

Amongft  the  ftimuli  that  may  be  directly  applied  to 
the  interlines,  and  which,  by  increaiing  their  periftal- 
tic  motion,  may  occafion  diarrhoea,   I   mud  not  omit 
to  mention  worms,  as  having  frequently  that  effect. 
MCCCCXCH. 

I  muft  alfo  mention  here  a  ftate  of  the  interlines, 
wherein  their  periftaltic  motion  is  preternaturally  in- 
creafed,  and  a  diarrhoea  produced ;  and  that  is,  when 
they  are  affected  with  an  erythematic  inflammation. 
With  refpect  to  the  exiflence  of  fuch  a  ftate,  and  its 
occasioning  diarrhoea,  fee  what  is  faid  above  in  ccc- 
xcvm.  and  following.  Whether  it  is  to  be  confcder- 
ed  as  a  particular  and  diftinct  cafe  of  diarrhoea,  or  is 
always  the  fame  with  fome  of  thofe  produced  by  one 
or  other  of  the  caufes  abo/e  mentioned,  I  have  not 
been  able  to  determine. 

MccccxciiF. 

Laftly,  by  an  accumulation  of  alimentary  or  of  o- 
ther  matter  poured  in  the  cavity  of  the  inteftines  from 
feveral  of  the  fources  above  mentioned,  a  diarrhcea 

G  g  2  may 


236  PRACTICE 

may  be  efpecially  occasioned  when  the  abforprion  of 
the  lacteals,  or  of  other  abforbents,  is  prevented,  ei- 
ther by  an  obftruction  of  rheir  orifices,  or  by  an  ob- 
ftruction of  the  mefenteric  glands,  through  which 
alone  the  abforbed  fluids  can  be  tranfmirted. 

In  one  inftance  of  this  kind,  when  the  chyle  pre- 
pared in  the  ftomach  and  duodenum  is  not  abfoibed  in 
the  courfe  of  the  inteftines,  but  paffes  off  in  confidera- 
ble  quantity  by  the  anus,  the  difeafe  has  been  named 
Morbus  Cce/iaca^  or  limply  and  more  properly  Coe/iaca; 
which  accordingly  I  have  conlidered  as  a  fpecies  of 
diarrhoea. 

MCCCCXCIV. 

I  have  thus  endeavoured  to  point  out  the  various 
fpecies  of  difeafe  that  may  come  under  the  general 
appellation  of  Diarrhoea ;  and  from  that  enumeration 
it  will  appear,  that  many,  and  indeed  the  greater  part 
of  the  cafe  of  diarrhoea,  are  to  be  coniidcred  as  fympa- 
thetic  affections,  and  to  be  cured  only  by  caring  the 
primary  difeafe  upon  which  they  depend  ;  of  which, 
however,  I  cannot  properly  treat  here.  From  Our1 
enumeration  it  will  alfo  appear,  that  many  of  the  ca- 
fes of  diarrhoea  which  may  be  confidered  as  idiopa- 
thic,  will  not  require  my  laying  |nuch  of  them  here. 
In  many  instances,  the  uiieaie  is  afcertained,  and  alfo 
the  cauieailigned,  by  the  condition  of  the  matter  e- 
vacuated  ;  fo  that  what  is  neceilary  to  correct  or  re- 
move it  will  be  fufficiently  obvious  to  practitioners  of 
any  knowledge.  In  ihoit,  I  do  not  find  that  lean  of- 
fer any  general  plan  for  the  cure  of  diarrhoea  ;  and 
all  that  I  can  propoie  to  do  on  this  fubject,  is  to  give 
Ibme  general  rem irks  on  the  practice  that  has  been 
commonly  followed  in  the  cure  of  this  difeafe. 
MCCCCXCV. 

The  practice  in  nis  difeafe  has  chiefly  proceeded 
upon  the  fupp^fition  or   an  acrimony  in  the  fluids,  or 
of  a  laxity  in  the  fimpie  and  moving  fibres  of  the  in- 
teftines; 


O  F    P  H  Y  S  I  C.  237 

;  and  the  remedies  employed  have  according- 
ly been  Correctors  of  particular  acrimony,  general 
demulcents,  evacuants  by  vomiiing  or  purging,  af- 
tringents,  or  opiates.  Upon  each  of  thefe  kinds  of 
remedy  1  mail  now  offer  fome  remarks. 
MGCCCXCVI. 

An  acid  acrimony  is,  upon  feveral  occalions,  the 
caufe  of  diarrhoea,  particularly  in  children ;  and  in 
fuch  cafes  the  abforbent  earths  have  been  very  proper- 
ly employed.  The  common,  however,  and  promif- 
cuous  ufe  of  thefe  has  been  very  injudicious  ;  and 
where  there  is  any  putrefcency,  they  mud  be  hurtful. 
MCCCCXCVII. 

The  cafes  in  which  there  is  a  putrid  or  putrefcent 
acrimony  prevailing,  have  been,  I  think,  too  feldom 
taken  notice  of;  and,  therefore,  the  ufe  of  acids  too 
feldom  admitted.  The  acrimony  to  be  fufpeded  in 
bilious  cafes,  is  probably  of  the  putrefcent  kind, 
MCCCCXCVIII. 

The  general  correctors  of  acrimony  are  the  mild 
diluents  and  demulcents.  The  former  have  not  been 
fo  much  employed  in  diarrhoea  as  they  ought ;  for, 
joined  with  demulcents,  they  very  much  increafe  the 
effects  of  the  latter :  and  although  the  demulcents, 
both  mucilaginous  and  .oily,  may  by  themfelves  be 
ufeful,  yet  without  the  affiftance  of  diluents  they  can 
hardly  be  introduced  in  fuch  quantity  as  to  anfwer  the 
purpofe*. 

MCCCCXCIX. 

*  Lintleed-tea  is  both  diluent  and  demulcent  ;  but  as  the  patient 
fometimes  loaths  it,  we  may  in  its  place  ufe  a  deception  of  inarfh- 
m  allows  root,  or  of  quince  feed.  Thefe  mfufions  and  decoctions 
ought  to  be  extremely  thin.  An  ounce  of  bruifed  quince-feed  will 
make  three  pints  of  water  as  thick  and  ropy  as  the  white  of  an  egg  j 
hence  a  drachm  is  fufficient  for  a  pint  of  the  decoction, 

We  have  another  inf'ance  of  a  diluent  and  demulcent  in  the  al- 
mond emulhon.  which  is  an  exceedingly  elegant  medicine.  The 
formulae  in  both  the  L,ondon  and  Edinburgh  Pharmacopoeias  are  not 
Well  adapted  to  cafes  of  diarrhoea  :  for  the  former  contains  fugar, 


PRACTICE 

MCCCCXCIX. 

As  indigeilion  and  crudities  pr.efent  in  the  flora  ack 
are  io  often  the  caufe  of  diarrhoea,  vomiting  mud 
therefore  be  frequently  very  ufeful  in  this  difeaie. 

In  like  manner,  when  the  difeafe  proceeds,  as  it  oft- 
en does,  from  obflrucled  perfpiration,  and  increafed 
afflux  of  fluids  to  the  interlines,  vomiting  is  perhaps 
the  mofi  effectual  means  of  reftoring  the  determina- 
tion of  the  fluids  to  the  ftirface  of  the  body. 

It  is  poilible  alfo,  that  vomiting  may  give  fome  in- 
verfion  of  the  periilaltic  motion  which  is  determined 
too  much  downwards  in  diarrhcea  ;  fo  that  up9n  the 
whole  it  is  a  remedy  which  may  be  very  generally  ufe- 
ful in  this  difeafe*. 

MD. 

Purging  has  been  fuppofed  to  be  more  univerfally 
necelTary,  and  has  been  more  generally  practifed. 
This  however,  in  my  opinion,  proceeds  upon  very  mif- 
taken  notions  with  refpecl  to  the  difeafe  ;  and  fuch  a 
practice  feems  to  me  for  the  moft  part  fuperfluous,  and 
in  many  cafes  very  hurtful  It  goes  upon  the  fuppo- 
fition  of  an  acrimony  prefent  in  the  inteftines,  that 
ought  to  be  carried  out  by  purging  :  but,  if  that  acri-' 
mony  has  either  been  introduced  by  the  mouth,  or 
brought  into  the  inteftines  from  other  parts  of -the 
body,  purging  can  neither  be  a  means  of  correcting 
nor  of  exhaulling  it ;  and  muft  rather  have  the  effecl 
of  indenting  its  afflux,  and  of  aggravating  its  effects. 

From 

and  the  latter  oitter  almonds  ;  both  of  which  increafe  the  irritation. 
In  thefe  cafes,  therefore,  an  emulfion  made  with  fwcet  almonds  and 
gum  arabic,  is  preferable  to  either  of  the  others  :  as, 
%>.  Arnygdal.  dulc.  decorticat.  31*. 

Gum  Arabic.  31. 

Tere  in  mortario  marmoreo,  et  addc  gradatim. 

Aq.  font.  Ib.  i. 

M.f.  Emulf. 

*  The  methods  of  giving  the  tartar  emetic,  for  producing  cither 
vomiting  or  fwcating,  may  be  fccn  in  the  notes  on  article  185, 


OFF  II  Y  S  I  C. 

From  whatever  fource  the  acrimony  which  can  excite 
a  diarrhoea  proceeds,  it  may  be  fuppofed  fufficient  to 
evacuate  itfelf,  fofaras  that  can  be  done  by  purging  ; 
and  as  in  cholera,  fo  in  the  fame  kind  of  diarrhoea,  it 
will  be  more  proper  to  aflift  the  evacuation  by  diluents 
and  demulcents,  than  to  increafe  the  irritation  by  pur- 
gatives, 

MDI. 

If,  then,  the  ufe  of  purgatives  in  diarrhoea  may  be 
confidered,  even  when  an  acrimony  is  prefent,  as  fu- 
peril  uous,  there  are  many  other  cafes  in  which  it  may 
be  extremely  hurtful.  If  the  irritability  of  the  intef- 
tines  mail,  from  affections  in  other  parts  of  the  fyftem, 
or  other  caufes,  have  been  already  very  much  increaf- 
ed}  purgatives  muft  neceiiarily  aggravate  the  difeafc, 
In  the  cafe  of  lientcry,  nobody  thinks  of  giving  a  pur- 
gative ;  and  in  many  cafes  of  diarrhoea  approaching 
to  that,  they  rnuft  be  equally  improper.  I  have  al- 
ready obferved,  that  when  diarrhoea  proceeds  from  an 
afflux  of  fluids  to  the  interlines,  whether  in  too  great 
quantity,  or  of  an  acrid  quality,  purgatives  may  be 
hurtful ;  and  whoever,  therefore,  conriders  the  nu- 
merous and  various  fources  from  which  acrid  matter 
may  be  poured  into  the  cavity  of  the  interlines,  will 
readily  perceive,  that,  in  many  cafes  of  diarrhcea,  pur- 
gatives may  be  extremely  pernicious. 

There  is  one  cafe  in  particular  to  be  taken  notice 
of.  When,  from  a  general  and  acrid  diifolution  of 
the  blood,  the  ferous  fluids  run  off  too  copiotiily  into 
the  cavity  of  the  inteftines,  and  excite  that  diarrhoea 
which  attends  the  advanced  flate  of  heclic  fever,  and 
is  properly  called  a  Colliquative  Diarrhoea  ;  I  have,  in 
fuch  cafes,  often  feen  purgatives  given  with  the.  moil 
baneful  effects. 

There  is    flill  another  cafe   of  diarrhoea  in  which 
purgatives  are  pernicious  ;  and  that  is,  when  the  dif- 
eafc  dependsj  as  we  have  alledged  it  forr.etimes  may 
upon  an  erythematic  inflammation  of  the  interlines. 

I  need 


240  PRACTICE 

I  need  hardly  add,  that  if  there  be  acafe  of  diarrhcea 
depending  upon  a  laxity  of  the  folids,  purgatives  can- 
not there  be  of  any  iervice,  and  may  do  much  harm. 
Upon  the  whole,  it  will,  I  think,  appear,  that  the  ufe 
of  purgatives  in  diarrhoea  is  very  much  limited;  and 
the  promifcuous  life  of  them,  which  has  been  fo  com- 
mon, is  injudicious,  and  often  pernicious.  I  believe 
the  practice  has  been  chiefly  owing  to  the  ufe  of 
purgatives  in  dyfenteric  cafes,  in  which  they  are  truly 
ufeful  ;  becaufe,  contrary  to  the  cafe  of  diarrhoea,  there 
is  in  dyfcntery  a  coniiderable  conftri&ion  of  the  intef- 
tines*. 

MDIL 

Another  fet  of  remedies  employed  in  diarrhoea  are 
aftringents.  Tfrere  has  been  fome  heiitation  about 
the  employment  of  thefe  in  recent  cafes,  upon  the 
fuppoiition  that  they  might  occaiion  the  retention  of 
an  acrid  matter  that  fhouid  be  thrown  out.  I  cannot, 
however,  well  underfland  or  aflign  the  cafes  in  which 
fuch  caution  is  neceflary  ;  and  I  think  that  the  power 
of  ailringents  is  feldom  fo  great  as  to  render  their  ufc 

very 

*  Notwithstanding  all  the  author  advances  concerning  the  danger 
of  purgatives  in  a  dianhcsa,  there  are  fome  cafes  in  which  they  are 
of  fingular  utility.  His  arguments  in  this  article  are  doubtlefs 
iuft  ;  and,  in  the  fpecies  of  diarrhcea  which  he  here  enumerates,  pur- 
g-atives  arc  certainly  hurtful  :  but  many  inftances  of  diarrhoea  occur, 
which  proceed  from  an  acrimony  that  is  extremely  tenacious,  and 
that  adheres  clofely  to  the  internal  furface  of  the  intelline*,  or  is  re- 
tained in  their  folds.  In  fuch  cafes,  purgatives  are  the  only  re- 
medies for  removing  the  difeafe,  and  ought  therefore  to  be  uft  d.  In 
ail  other  cafes,  (as  the  author  jultly  obferves,)  they  are  certainly 
pernicious. 

Having  afcertained  when  purgatives  are  proper,  the  next  confi- 
oeration  is,  what  purgatives  ought  to  be  ufcd  ?  The  anf\ver  is  obvi- 
ous : — Neutral  falts,  particularly  ^oda  phofphorata,  Rochel  Salt, 
Glauber's  falts,  and  Epfora  ia!t,  which  are  enumerated  in  the  order 
of  their  being  agreeable,  but'  in  a  contrary  order  to  their  degree 
of  efficacy;  the  E^'V-ni  idlt  being  the  kail  agreeable,  but  lhs 
inoil  tiiic.'.clous. 


OF    PHYSIC.  241 

• 

very  dangerous.  The  only  difficulty  which  has  occur- 
red to  me,  with  refpecl  to  their  ufe,  has  been  to  judge  of 
the  circumftances  co  which  they  are  efpecially  adapt- 
ed. It  appears  to  me  to  be  only  in  thofe  where  the 
irritability  of  the  inteflines  depends  upon  a  lofs  of 
tone :  and  this,  I  think,  may  occur  either  from  the 
debility  of  the  whole  fyftem,  or  from  cauies  acling  on 
the  interlines  alone.  All  violent  or  long-cominued 
fpafmodic  and  convullive  affe&ions  of  the  imeitinai 
canal  neceffarily  induce  a  debility  there;  and  fuch 
caufes  often  take  place,  from  violent  irritation,  in  co* 
lie,  dvfentery,  cholera,  and  diarrhoea*. 

MDiII. 

The  laft  of  the  remedies  of  diarrhoea  that  remain  to 
VOL.  II.  H  h  be 

*  The  aftringcnts  to  be  ufed  when  they  arc  proper,  are  various  c- 
as  Alum,  Logwood,  Catechu,  Rhubarb,  &c.  The  author  juftly 
remarks,  that  aftringents  are  only  ufeful  in  cafes  of  debility,  and 
therefore  the  tonic  aftringents.are  undoubtedly  preferable  to  any 
other.  Rhubarb  and  Peruvian  bark,  each  poifeffihg  both  thefe  qua- 
lities, may  therefore  be  advantageoufly  ufed  conjointly,  as  in  the 
following  formula  : 

5..  Pulv.  Cort.  Peruv.  §i. 
Rad,  Rhei,  gfs. 
M.  f.  Pulv. 

The  dofe  of  this  powder  may  be  varied  according  to  circumflances, 
from  a  fcruple  to  a  dram,  twice  a-day,  with  a  glafs  of  port  wine 
after  it. 

It  may  not  be  improper  to  obferve,  that  in  diarrhoeas  in  general 
peculiar  attention  muft  be  paid  to  diet.  The  oleraceous  and  acef- 
cent  vegetables  muft  be  carefully  avoided  ;  as  muft  alfo  all  fermented 
liquors  except  port  wine  ;  of  the  farinaceous  vegetables,  rice  is  the 
belt ;  arid  rice-water,  with  a  little  cinnamon  and  port  wine,  is  the 
moll  proper  drink  for  patients  in  thefe  cafes.  Roafted  meats  are 
preferable  to  boiled  ;  and  veal,  lamb,  or  chickenF,preferable  to  beef 
or  mutton.  Pork  is  very  improper,  as  are  alfo  all  kinds  of  fifh. 
Puddings  of  ail  kinds  without  fruit  are  very  proper  food  for  fuch 
patients,  efpecially  rice-puddings  made  without  eggs,  but  with  milk 
and  cinnamon  ;  and  alfo  rice- milk,  fago  with  port  wine,  blanc 
mange,  &c. 


P  R  A  C  T  I  C  E 

be  mentioned  are  opia'e?.  The  fame  objections  have' 
been  made  to  the  ufe  -of  thefe,-in  recent  cafes  of  diar- 
rhoea, as  to  that  rf  aftringents  ;  but  on  no  good 
grounds  :  for  the  effect  of  opiates,  as  aftringent,  is  ne- 
ver very  permanent ;  and  an  evacuation  depending 
upon  irritation,  though  it  may  be  for  foaie  thnefuf-. 
pended  by  opiates,  yet  always  returns  very  foon.  It 
is  only  by  taking  off  irritability  that  opiates  are  ufeful 
in  diarrhoea;  and  therefore,  when  the  diieafe  depends 
upon  an  increafe  of  irritability  alone,  or  when,  though 
proceeding  from  irritation,  that  irritation  is  corrected 
or  exhausted,  opiates  are  the  moil:  ufeful  and  certain- 
remedy.  And  thoughopiates  are  not  fuited  to  correct 
or  remove  an  imraiionapplied,  they  are  often  of  great 
benefit  in  fufpending  the  effects  of  that  irritation 
whenever  theie  are  violent  :  and,  upon  the  whole, 
it  will  appear,  that  opiates  "may  be  very  frequently, 
and  with  great  propriety,  employed  in  the  cure  of 
diarrhcea. 


T 


C     H     A     P.       XII. 


O  F     T  HE     DIABETES. 


MDIV. 

HIS  difeafe  confifts  in  the  voiding  of  an 


large  quantity  of  urine. 

As  hardly  any  fecvetion  can  be  increafed  without 
an  increafed  Action  of  the  vefTels  concerned  in  it,  and 
as  forne  inilances  of  this  difeafe  are  attended  with  affec- 
tions manifeflly  fpafmodic,  I  have  had  no  doubt  of 
arranging  the  diabetes  under  the  order  of  Spafmi. 

MDV. 

This  difeafe  is  always  accompanied  with  a  great  de- 

gree 


O  I'      'P  H  Y  S  I  C.  243 

grce  of  thiril,  and  therefore  with  the  taking  in  of  a 
great  quantity  of  drink.  This  in  fome  meafure  ac- 
counts for  the  very  extraordinary  quantities  of  urine 
voided:  but  fall,  independent  of  this,  peculiar  dif- 
eafe  certainly  takes  place;  as  the  quantity  of  urine 
voided  does»almoil  always  exceed  the  whole  of  the 
liquids,  and  fomttiraes  ihe  whole  of  both  folids  and  li- 
quids, taken  in.. 

MBW, 

The  urine  voided  in  this  difcafe  is  always  very  clear, 
and  at  fir  ft  fight  appears  entirely  wiih^m  any  colour  : 
but,  viewed  in  a  certain  light,  it  generally  appears 
to  be  flightlyv  tinned  with  a  yeliowifl}  green,  and 
in  thi^  refpecl  has  been  very  properly  compared  to  a 
folution  of  honey  in  a  large  proportion  of  water. 

Examined  by  the  tafte,  it  is  very  generally  found 
to  be  more  or  lefs  fweet ;  and  many  experiments  that 
have  now  been  made  in  different  inftances  of  the  dif- 
eafe,  fhow  clearly  that  fuch  urine  contains,  in  confider- 
able  quantity,  a  faccharine  matter  which  appears  to  be 
very  exactly  of  the  nature  of  common  fugar. 

MDVIL 

Dc&or  Willis  feems  to  me  to  have  been  the  firiv 
who  took  notice  of  the  fweetnefs  of  the  urine  in  dia- 
betes, and  almoft  every  phyfician  of  England  has  fince 
taken  notice  of  the  fame.  It  is  to  be  doubted,  indeed, 
if  there  is  any  cafe  of  idiopathic  diabetes  in  which  the 
urine  is  of  a  different  kind.  Though  neither  the  an- 
dents,  nor,  in  the  other  countries  of  Europe,  the  mo- 
derns,  till  the  latter  were  direcled  to  it  by  the  Englifh, 
have  taken  notice  of  the  fweetnefs  of  the  urine,  it  does 
not  perfuade  me,  that  either  in  ancient  or  in  modern 
times  the  urine  in  diabetes  was  of  another  kind.  I 
myfelf,  indeed,  think  I  have  met  with  one  inftance 
of  diabetes  in  which  the  urine  was  perfectly  infipid  ; 
and  it  would  feem  that  a  like  obfervation  had  occur- 
red to  Dr.  Martin  Lifter.  I  am  perfuaded,  however, 
H  h  2  that 


344  PRACTICE 

that  Rich  inflances  are  very  rare ;  and  that  the  other 
is  by  much  the  more  common,  and  perhaps  the  al- 
rnoft  univerfal  occurrence.  I  judge,  therefore,  that 
the  prefence  of  fuch  a  faccharine  matter  may  be  con- 
fidered  as  the  principal  circumftance  in  idiopathic  di- 
abetes ;  and  it  gives  at  leaft  the  only  cafeaof  that  dif- 
eafe  that  I  can  properly  treat  of  here,  for  I  am  only 
certain  that  what  I  am  further  to  mention  relates  to 
fuch  a  cafe. 

MDVIIL 

The  antecedents  of  this  difeafe,  and  confequently 
the  remote  caufes  of  it,  have  not  been  well  afcertain- 
ed.  It  may  be  true  that  it  frequently  happens  to  men 
who,  for  a  long  time  before,  had  been  intemperate  in 
drinking  ;  that  it  happens  to  perfbns  of  a  broken  con- 
ftitution,  or  who,  as  we  often  exprefs  it,  are  in  a 
cachecYic  ftate  ;  that  it  fometirnes  follows  intermit- 
tent fevers  ;  and  that  it  has  often  occurred  from  excefs 
in  the  drinking  of  mineral  waters.  But  none  of  thefe 
caufes  apply  very  generally  to  the  cafes  that  occur: 
fuch  cafes  are  not  always,  nor  even  frequently,  fol- 
lowed by  a  diabetes  ;  and  there  are  many  inftances  of 
diabetes  which  could  not  be  referred  to  any  of  them, 
In  mod  of  the  cafes  of  this  difeafe  which  I  have  met 
with,  I  could  not  refer  it  to  any  particular  caufe. 

MD1X. 

This  difeafe  commonly  comes  on  flowly,  and  almoft 
imperceptibly,  without  any  previous  diforder.  It  of- 
ten rifes  to  a  coniiderable  degree,  and  fubfifts  long 
without  being  accompanied  with  evident  diforder  in 
any  particular  part  of  the  fyftem.  The  great  third 
\vhich  always,  and  the  voracious  appetite  which  frer 
quently  occurs  in  it,  are  often  the  only  remarkable 
fymptoms.  Under  the  continuance  of  the  difeafe,  the 
body  is  often  greatly  emaciated  ;  and  a  great  weak- 
nefs  alfo  prevails.  The  pulfe  is  commonly  frequent  ; 
and  an  obfcure  fever  is  for  the  moft  part  prefent. — 
When  the  difeafe  proves  fatal,  it  generally  ends  with 

a  fever 


OF    PHYSIC.  245 

a  feve'r,  in  many  circnmflances,   particularly  thofe  of 
emaciation  and  debility,  refembling  a  hectic: 

MDX. 

The  proximate  caufe  of  this  difeafe  is  not  certainly 
or  clearly  known.  It  feems  to  have  been  fometimes 
connected  with  calculous  affections  of  the  kidneys  ;  and 
it  is  poffible,  that  an  irritation  applied  there  may  in- 
creafe  the  fecretion  of  urine.  It  perhaps  often  does 
fo  ;  but  how  it  fhould  produce  the  lingular  change 
that  takes  place  in  the  ftate  of  the  urine,  is  not  to  be 
eaiily  explained.  It  certainly  often  happens,  that  cal- 
culous matters  are  long  prefect  in  the  urinary  paffages, 
without  having  any  fuch  effect  as  that  of  producing 
diabetes  in  any  ihape. 

Some  have  fuppofed  that  the  difeafe  occurs  from  a 
relaxed  ftate  of  the  fecretory  vefTels  of  the  kidneys  ; 
and  -indeed  the  diflections  of  perfons  who  had  died  of 
this  difeafe  have  ihown  the  kidneys  in  a  very  flaccid 
{late.  This,  however,  is  probably  to  beconfidered  as 
rather  the  effect  than  the  caufe  of  the  difeafe* 

That  no  topical  affection  of  the  kidneys  has  a  (bare 
in  producing  this  difeafe,  and  thnt  a  fault  in  the  an% 
m ulation  of  the  fluids  is  rather  to  be  blamed,  I  con- 
clude from  hence,  that  even  the  folid  food  taken  in, 
increafes  the  quantity  of  the  urine  voided,  at  the  fame 
time  with  an  increafe  of  the  faccharine  matter  above- 
mentioned. 

MDXI. 

The  diabetes  has  been  fuppofed  to  be  owing  to  a 
certain  ftate  of  the  bile  ;  and  it  is  true,  that  this  difeafe 
has  fometimes  occurred  in  perfons  who  were  at  the 
•  fame  time  affected  with  difeafes  of  the  liver  :  but  this 
occurrence  does  not  ofren  take  place ;  and  the  diabe- 
tes frequently  occurs  feparately  from  any  affection  of 
the  liver.  In  twenty  inflances  of  diabetes  which  I 
have  fcen?  there  was  not  in  any  one  of  them  any  evi- 
dent affection  of  the  liver. 

Tie 


.246  PRACTICE 

The  explanation  that  has  been  offered  of  the  nature 
and  operation  of  the  bile,  in  producing  diabetes,  is  ve- 
ry hypothetical,  and  nowife  Satisfying. 

MDXII. 

As  I  have  already  faid,  I  think  it  probable,  that  in 
moft  cafes  the  proximate  caufe  of  this  difeafe  is  fome 
fault  in  the  aflimilatory  powers,  or  in  thofe  employed 
in  converting  alimentary  matters  into  the  proper  ani- 
mal fluids.  This  I  formerly  hinted  to  Dr.  Dobfon, 
and  it  has  been  profecuted  and  publifhed  by  him  ; 
but  I  mufl  own  that  it  is  a  theory  embarraffed  with 
fome  difficulties  which  I  cannot  at  prefcnt  very  wjsll 
remove. 

MDXIIL. 

The  proximate  caufe  of  diabetes  being  fo  little 
known  or  afcertained,  I  cannot  propofe  any  rational 
method  of  cure  in  the  difeafe*.  From  the  teftimony 
tif  fever  a)  authors,  I  believe  that  the  difeafe  has  been 
cured:  but  I  believe  alfo?  that  this  has  feldom  happen- 
ed ;  and  when  the  difeafe  has  been  cured,  I  doubt 
much  if  it  was  effected  -by  the  feveral  remedies  to 
which  thefe  cures  have  been  afcribed.  In  all  the  in- 
ftances  of  this  difeafe  which  I  myfelf  havefeen,  and  in 

feveral 

*  The  difeafe  is  happily  not  very  common  ;  but,  when  a  phyfici^ 
an  is  called,  he  is  under  the  neceffity  of  doing  fomething,  and  not 
remaining  inactive.  Some  general  directions  may  therefore  be  ac- 
ceptable to  the  young  pra&itioncr. 

The  cure  will  principally  confiil  in  avoiding  whatever  may  relax 
the  renal  veffels,  efpecially  by  avoiding  ilrong  drink.  As  the  quan- 
tity of  urine  is  always  lefs  in  proportion  as  the  perfpiration  is  in- 
creafed,  it  feems  adviiable  to  keep  the  furface  of  the  fkin  lax  and 
perfpirable  ;  and,  if  the  patient's  ftrength  allows  him,  he  ought  fre- 
quently to  ufe  bodily  exercife  to  promote  fvveat.  For  afimilar  r'ea 
fon,  external  cold  muft  be  avoided,  becaufe  by  diminiming  perfpira- 
tion, a  targer  quantity  of  fluids  is  derived  to  the  kidneys. 

la  fome  cafes,  the  difeafe  may  be  probably  owing  to  a  lax  or 
weak  ftatc  of  the  kidneys  :  hence  the  indication  of  tonics,  as  Peru- 
vian bark,  and  other  tonic  bitters. 


OF    P  II  Y  S  I  C.  247 

feveral  others  of  which  I  have  been  informed,  no  cure 
of  it  has  ever  been  made  in  Scotland,  though  many 
inftances  of  it  have  occurred,  arid  in  mofl  of  thfm  the 
remedies  recommended  by  authors  have  been  diligent- 
ly employed.  I  cannot,  therefore,  with  any  advan- 
tage, enter  into  a  detail  of  thefe  remedies  ;  and  as  the 
difeafe,  together  with  its  feveral  circumftances,  when 
they  fhall  hereafter  occur,  is  likely  to  become  the  fub- 
ject  of  diligent  investigation,  I  avoid  going  farther  at 
prefent,  and  judge  it  prudent 'to  fufpend  my  opinion 
till  I  ihall  have  more  observations  and  experiments  up- 
on which  I  can  form  it  more  clearly. 


CHAP.        XIII. 

OF  THE  HYSTERIA,    OR  THE  HYSTERIC 
DISEASE. 

MDXIV. 

r  |  ^HE  many  and  various  fymptoms  which  have  been 
_§,  fuppofed  to  belong  to  a  difeafe  under  this  appella- 
tion, render  it  extremely  difficult  to  give  a  general 
character  or  definition  of  it.  It  is,  however,  proper 
in  all  cafes  to  attempt  fome  general  idea  ;  and  there- 
fore, by  taking  the  mod  common  form,  and  that  con- 
currence of  fymptoms  by  which  it  is  principally  dif- 
tinguiihed,  I  have  formed  a  character  in  my  fyltern  of 
Methodical  Nofology,  and  (hall  here  endeavour  to  il- 
luilrate  it  by  giving  a  more  full  hiftory  of  the  pheno- 
mena. 

MDXV. 

The  difeafe  attacks   in   pr.roxyf.ns  or  fits.      Thefe 
commonly  begin  by  fome  pain  and  fulnefs  felt  in.  the 

left 


448  P  R  A  C  T  I  C  £ 

left  fide  of  the  belly.  From  this  a  ball*  feerns  to  move 
with  a  grumbling  noiie  into  the  other  parts  of  the  bel- 
ly ;  and,  making  as  it  were  various  convolutions 
there,  feerns  to  move  into  the  ftomach  ;  and  more 
distinctly  ftill  rifes  up  to  the  top  of  the  gullet,  where 
it  remains  for  fome  time  and  by  its  p  re  flu  re  upon  the 
larynx  gives  a  fenfe  of  fuffocation.  By  the  time  that 
the  difeafe  has  proceeded  thus  far,  the  patient  is  af- 
fe&ed  with  a  flupor  and  infer  niibility,  while  at  the  fame 
time  the  body  is  agitated  with  various  convulficns. 
The  trunk  of  the  body  is  wreathed  to  and  fro,  and 
the  limbs  are  varioufly  agitated  ;  commonly  the  con- 
vulfive  motion  of  one  arm  and  hand,  is  that  of  beating 
writh  the  clofed  fift,  upon  the  brealt  very  violently 
and  repeatedly.  This  ftate  continues  for  fome  time, 
and  has  during  that  time  fome  remiffions  and  renew- 
als of  the  convuliive  motions  ;  but  they  at  length 
ceafe,  leavKg  the  patient  in  a  ftupid  and  feemingly 
ileeping  ftate.  More  or  lefs  fuddenly,  and  frequently 
with  repeated  fighing  and  fobbing,  together  with  a 
murmuring  noife  in  the  belly,  the  patient  returns  to 
the  exercife  of  fenfe  and  motion,  but  generally  with- 
out any  recollection  of  the  feveral  circumllances  that 
had  taken  place  during  the  fit. 

MDXVI. 

This  is  the  form  of  what  is  called  an  byjleric parox- 
yfm,  and  is  the  mod  common  form  ;  but  its  p-.irox- 
yfms  are  confiderably  varied  in  different  perfons,  and 
even  in  the  fame  perfon.at  different  times.  It  differs, 
by  having  more  or  fewer  of  the  circumflances  above- 
mentioned  :  by  thefe  circumftances  being  more  or 
lefs  violent ;  and  by  the  different  duration  of  the 
•whole  fit. 

Before  the  fit  there  is  fomctimes  a  fudden  and  unu- 
fually  large  flow  of  limpid  mine.  At  the  coming  on 

of 

*   Commonly  called  Glubus  hyfiericus  by  authors. 


OF    P  PI  Y  S  I  C.  249 

of  the  fit,  the  ftomach  is  fometimes  affected  with  vo- 
miting, the  lungs  with  coniiderable  difficulty  of  breath- 
ing, and  the  heart  with  palpitations.  During  the  fit, 
the  whole  of  the  belly,  and  particularly  the  navel,  is 
drawn  flrongly  inwards ;  the  iphincter  and  ani  is  fome- 
times  fo  firmly  conducted  as  not  to  admit  a  fmall 
glyiter-pipe,  and  there  is  at  the  fume  time  an  entire 
fuppreffion  of  urine.  Such  fits  are,  from  time  to  time, 
ready  to  recur;  and  during  the  intervals,  the  patients 
are  liable  to  involuntary  motions,,  to  fits  of  laughing 
and  crying,  with  fudden  tranfition  from  the  one  to  the 
other  ;  while  fometimes  falie  imaginations,  and  fume 
degree  of  delirium,  alfo  occur. 

MDXVIL 

Thefe  affections  have  been  fuppofed  peculiar  to  the 
female  iex ;  and  indeed  they  moil  commonly  appear 
in  females  :  but  they  fometirnes,  though  rarely,  at- 
tack the  male  fex ;  never,  however,  that  I  have  ob- 
ferved,  in  the  fame  exquiiite  degree. 

In  the  female  fex5  the  difeafe  occurs  efpeciallv 
from  the  age  of  puberty  to  that  of  thirty-five  years ; 
and  though  it  does-  fometimes,  yet  very  feldom  ap- 
pears before  the  former  or  after  the  latter  of  thefe  pe- 
riods. 

At  all  ages,  the  time  at  which  it  rrfoft  readily  occurs 
is  that  of  the  menftrual  period. 

The  difeafe  more  efpecialiy  affects  the  females  of 
the  moil  cxquifitely  fanguine  and  plethoric  habits^ 
and  frequently  affects  thofe  of  the  moll  robufl  and  maf- 
culine  conftitutions. 

It  affects  the  barren  more  than  breeding  \vcmen, 
and  therefore  frequently  young  widows. 

It  occurs  efpecialiy  in  thofe  female^  who  are  liable 
to  the  Nympbomania  ;  and  the  Nofologifls  have  pro- 
perly enough  marked  one  of  the  varieties  of  this  dif- 
eafe by  the  title  of  Hyfieria  Libidinofa. 

In  the  perfons  liable  to  the  fits  of  this  difeafe,  it  is 

VOL,  II.  I  i  readily 


PRACTICE 

readily  excited  by  the  paffions  of  the  mind,  and  by 
every  conliderable  emotion,  efpecially  thofe  brought 
on  by  furprife. 

.     The  perfons  liable  to  this  difeafe  acquire  often  fuch 
a  degree  of  fenfibility,   as  to  be  ftrongly  affected  by 
every  hnpreffion  that  comes  upon  them  by  furprife. 
MDXVII1. 

In  this  hiftory,  there  appears  to  be  a  concurrence 
of  fymptoms  and  circumitances  properly  marking  a 
very  particular  difeafe,  which  I  think  may  be  diftin- 
guiihed  frorri  all  others.  It  feems  to  me  to  have  been 
improperly  confidered  by  phyficians  as  the  fame  with 
fome  other  difeafes,  and  particularly  with  hypochon^- 
driafis.  The  two  difeafes  may  have  fome  fymptoms 
in  common,  but  for  the  moil  part  are  confiderably  dif- 
ferent. 

Spafmodic  affections  occur  in  both  difeafes;  but 
neither  fo  frequently  nor  to  fo  great  a  degree,  in  hy- 
pochondriafis as  in  hyfteria. 

Perfons  liable  to  hyfteria  are  fometimes  affected  at 
the  fame  time  with  dyfpepfia.  They  are  often,  how* 
ever,  entirely  free  from  it ;  but  I  believe  this  never 
happens  to  perfons  affected  with  hypochondriafis. 

Thefe  different  circumftances  mark  fome  difference 
in  the  two  difeafes  ;  but  they  are  ftill  more  certainly 
diftinguiihed  by  the  temperament*  they  attack,  and  by 
the  time§  of  life  at  which  they  appear  to  be  moil  ex- 
quifitely  formed. 

It  has  been  generally  fuppofed,  that  the  two  difeaf- 
es differ  only  in  refpeft  of  their  appearing  in  different 
fexes.  But  this  is  not  well  founded  :  for  although  the 
hyfteria  appears  moil  commonly  in  females,  the  male 

*  Hyfteria  attacks  the  fanguineand  plethoric,  but  Hypochondri- 
afis  the  melancholic. 

§  Hypochondriafis  fcarcely  ever  appears  early  In  life,  nor  HyfteJ 
ria  late  ;  and  Hypochondriacs  becomes  aggravated,  but  H-yttena  ;o 
lieved  by  advancing  age. 


Q  F    PHYSIC.  251 

fex  is  not  absolutely  free  from  it,  as  I  have  obfervcd 
above  ;  and  although  the  hypochondriafis  may  be 
moil  frequent  in  men,  the  inilaaces  of  it  in  t{ie  female 
fex  are  very  common*. 


From  all  thefe  confederations,  it  mutt  I  think,  ap* 
pear,  that  the  hyfterja  may  be  very  well,  and  properly., 
difiinguifhed  from  hypochondriacs. 

Further,  it  feems  to  me  to  have  been  with  great  im- 
propriety, that  almpfl  every  degree  of  the  irregular 
motions  of  the  nervous  fyflem  has  been  referred  to  the 
one  or  the  other  of  thefe  two  difeafes.  Both  are 
marked  by  a  peculiarity  of  temperament,  as  well  as 
by  certain  fytnptoms  commonly  accompanying  that  ; 
buii  fome  ot  thefe,  and  many  others  ufually  marked  by 
the  name  of  nervous  fymptoms,  may,  from  various 
caufes,  arife  in  temperaments  different  from  that  which 
is  peculiar  to  either  hyiieria  or  hypochondriafis,  and 
without  being  joined  with  the  peculiar  fymptoms  of 
either  the  one  or  the  other  difeafe  :  fo  that  the  appel- 
lations pf  Hyfteric  and  Hypochondriac  are  very  inac- 
curately applied  to  them.  Under  what  view  thefe 
fymptoms  are  otherwife  to  be  conliderecl,  I  am  not. 
ready  to  determine  ;  but  muft  remark,  that  the  appel- 
lation of  Nervous  Difeafes  is  too  vague  and  undetine4 
to  be  9f  any  ufeful  application. 

MDXX. 

Having  thus  endeavoured  to  diftinguifti  hyiieria 
from  every  other  difcafc,  I  fliali  now  attempt  its  pecu- 
liar pathology.  With  refpecl  to  this,  I  think  it  will, 
in  the  firfl  place,  be  obvious,  that  irs  paroxyfms.be- 
gin  by  sf  convulfive  and  fpafoodic  affection  of  the  ali- 
mentary canal,  which  is  afterwards  communicated  to 
the  brain,  and  to  a  great  part  of  the  nervous  fyflem. 

I  i  2  Although 

The  Hypochondriafis  in  women  has  frequently   been   miilaken 
for  Hyfteria. 


P  R  A  G  T  I  C  E 

Although  the  difeafe  appears  to  begin  in  the  alimen- 
tary canal,  yet  the  connexion  which  the  paroxyfms  fo 
often  have  with  the  menftrual  flux,  and  with  the  dif- 
eafes  that  depend  on  the  ftate  of  the  genitals,  fhows, 
that  the  phyficians  have  at  all  times  judged  rightly  in 
coniklerirsg  this  difeafe  as  an  affection  of  the  uterus 
and  other  parts  of  the  genital  fyftem. 
MDXXL 

With  regard  to  this,  however,  I  can  go  no  farther. 
In  what  manner  the  uterus,  and  particularly  the  ova- 
ria,  are  affected  in  this  difeafe ;  how  the  affection  of 
thefe  is  communicated,  with  particular  circumftances, 
to  the  alimentary  canal ;  or  how  the  affection  of  this, 
riling  up \varcls,  affects  the  brain,  fo  as  to  occafion 
the  particular  cc-nvulfions  which  occur  in  this  difeafe, 
I  cannot  pretend  to  explain. 

But  although  I  cannot  trace  this  difeafe  to  its  fvjft 
caufes,  or  explain  the  whole  of  the  phenomena,  I 
hope,  that  with  refpect  to  the  general  nature  of  the  dif- 
eafe, I  may  form  fome  general  conclufions,  winch  may 
itTve  to  direct  our  conduct  in  the  cure  of  it. 
MDXXII. 

Thus,  from  a  confideration  of  the  predifponent  and 
occasional  caufes,    it  \viil,  I  think,  appear,  that  the 
chief  parf  of  the  proximate  caufe  is  a  mobility  of  the 
fyilem,   depending  generally  upon  its  plethoric  ftate, 
MDXXI1I. 

Whether  this  difeafe  ever  arifes  from  a  mobility  of 
the  fyftem,  independent  of  any  plethoric  ftate  of  it,  I 
cannot  pofitjvely  determine  ;  but  in  many  cafes  that 
have  fubiiltcd  for  fome  time,  it  is  evident  that  aftn- 
iibilirv,  and  confequentiy  a  rnobili-y,  are  acquired/ 
which  often  appear  when  neither  a  general  plethora 
can  be  fuppofed  to  fubfift,  nor  an  occaiional  turgef- 
cence  to  have  happened.  However,  as  we  have 
fhown  above,  that  a  difteniion  of  the  vefTels  of  the 
brain  feems  to  occaiion  epilepfy,  and  that  a  turgef- 

cence 


OF      PHYSIC,  253 

cence  of  the  blood  in  t!\e  vefTds  of  the  lungs  feerns  to 
produce  afthma  ;  fo  analogy  leads  me  to  fuppofe,  that 
a  turgefcence  of  blood  in  the  uterus,  or  in  other  parts 
of  the  genital  iyftesn,  may  occafion  the  fpafmodic  and 
convfcliive  morions  "which  a  v>  ;>•-::  ar  in  hyfteria.  It  will, 
at  the  fame  I'Hie,  be  evident,  that  this  affection  of  the 
genitals  muil  especially  occur  in  plethoric  habits  ;  and 
every  circumftance  mentioned  in  the  hiftory  of  the 
difeafe  ferves  to  confirm  this  opinion  with  rcfpscl  to 
its  proximate  cauie. 

MDXXIV. 

From  this  view  of  the  fubjecl,  the  analogy  of  hyf- 
teria and  epiiepfy  will  readily  appear ;  and  why, 
therefore,  I  am  to  fay  that  the  indications  of  cure  lire 
the  fame  in  both. 

As  the  indications,  fo  the  feveral  means  of  anf.vcr- 
ing  them  are  fo  much  the  fame  in  both  difeaks,  that 
the  fame  obfervarions  and  directions,  with  regard  to 
the  choice  and  employment  of  thefe  remedies,  that 
have  been  delivered  above  on  the  ftibjecr  of  epi- 
iepfy, will  apply  pretty  exactly  to  hyfteria;  and  there- 
fore need  not  to  be  repeated  here*.  C  H  A  P. 

*  Although  the  indications  of  cure  maybe  the  fame  in  borh  dif- 
<eafe.c,  yet  in  hyfleria  we  arc  more  frequently  under  the  needier  of 
relieving  the  violence  of  the  fymptoms  than  in  rpilepfy  :  ;HK!  for 
this  puvpole  we  rauft  have  recoiirfo  to  n  v.uiely  of  z*ntifj 

A  fa  foci  Ida,  in  various  forms,  is  uiually  employed;  :  • 
volatile  fpirits:  bin;  both  thefe  joined,  prove  more  el 
either  of  them  finely.  There  are.  excellent  formulae  of  tin'-;  kin< 
the  London  and  Edinburgh  pharmacopoeias,  under  the  title  of  Soi- 
ritus  Amor.nie  foetidns.  It's  dofe  is  twenty  or  thirty  drops,  re- 
peated, according  to  the  urgency  of  the  ca^e,  feverul  times  a-day. 

The  'i  indura  CrtOorei  comp'.ifita  of  the  Edinburgh  l^liannaco- 
poeia  is  another  excellent  formula  of  the  fame  kind  ;  it  is  a  remcdv 
of  real  efficacy.  The  dcfe  of  it  is  thirty  or  forty  chops  repeated 
occafionally. 

The  Tfn&ura  Valcrianae  volitilis  of  both  tlie  pharmacopoeias  is1 
alfo  fiequently  ufcd.  It's  dofe  i^  a  lea-fpoonful  or  two. 

Few  of  the  coinpofitions  of  the  (hops  are  found  to  be  more  effi- 
cacious aritifpafmodics  than  the  Spiritus  ^Etheris  Vitriolicus  com- 
pofitus  of  the  London  Pharmacopeia.,  it's  cicfe  is  from  thirty  to 


254  PRACTICE 

C     H    A    P.      XIV. 

OF  CANINE  MADNESS  AND  HYDROPHOBIA. 

.MDXXV. 

TIIS  difeafe  has  been  ib  exactly  and  fully  defcrib- 
ed  ID  books  that  are  in  every  body's  hands,  that 
it  is  on  no  account  necefTiry  to  pve  any  hiftory  of  it 
here  ;  and  \vith  refpedl  to  the  pathology  of  it,  I  find 
that  I  can  fay  nothing  Satisfying  to  nryfelf,  or  that  I 
can  expect  to  prove  fo  to  others.  I  find  alfo,  with  re- 
fpedt  to  the  cure  of  this  difcafe,  that  there  is  no  fnb- 
jecl  in  which  the  fallacy  of  experience  appears  more 
ftrongly  than  in  this.  From  the  mod  ancient  to  the 
prefent  times,  many  remedies  for  preventing  and  cur- 


fifty  drops  in  two  or  three  fpoonfulls  of  cold  water  ;  and  it  rnuft  be 
f  wallowed  immediately  on  pouring  out  of  the  vial. 

Thefe  and  other  ar.tifpafmodics  mny  be  ufed  promlfcuoufly  ;  for, 
in  different  cafes  and  conilitutions,  they  prove  differently  efficacious. 
Sometimes  they  may  be  varioufly  combined  with  one  another,  and 
with  opium.  Opium,  however,  ought  not  to  be  ufed,  except  where 
other  antifpafmodics  fail,  as  it  always  'eaves  the  patient  lemarkably 
low,  and  liable  to  returns  of  the  paroxyfms. 

Beiides  theufe  of  thefe  remedies  internally,  fome  of  them  may  be 
ufefully  employed  externally  ;  as  ftvong  volatile  fpirits  to  the  nofe, 
the  vitriolic  aether  to  the  temples,  &c. 

Tliefe  remedies  are  chiefly  defigned  for  occafionally  removing  the 
violence   of  the  fymptoms  ;   but  the  fetid  gums,  in  fub.'lance,  mud 
be  uftd,  when  we  wiili  to  procure  permanent  effects .     The  formu- 
lae of  them  are  in  both  our  Pharmacopoeias,  under  the  title  of  gum- 
pills  ;  but  they  will   be  found  much  more  efficacious  by  adding  to 
them  a  little  caftor,  as  in  the  following  formula  : 
R,.  Pilul.  Gummof.  Edinb.  gfs. 
Callor  Ruflic,  5i. 
Syr.  'fimpl.  q.  1". 
M.  f.  maif.  in  pilulas  Ixxv,  equales  dividend. 

Five  of  thefe  pills  may  be  taken  twice  a-day  wafhing  them  co\vn 
\vith  a  tea-cupful  of  cold  water  with  a  tea-fpoonful  of  volatile  tinc- 
ture of  Valeria;;  in  it. 

The  Pilula?  fcetidce  of  the  Sweedifii  Pharmacopoeia,  in  which  caf- 
tor is  one  of  the  ingredients,  is  preferable  to  either  &f  qwr  gum-pills. 


O  F    P  H  Y  S  I  C.  255 

ing  this  difeafe  have  been  recommended  under  the 
fanction  of  pretended  experience,  and  have  perhaps 
alfo  kept  their  credit  for  forae  time:  but  fucceeding 
times  have  generally,  upon  the  fame  ground  of  expe- 
rience, deftroyed  that  credit  entirely  ;  and  mod  of  the 
remedies  formerly  employed  are  now  fallen  into  abfo- 
lute  neglect.  In  the  prefent  age,  foinc  new  remedies 
have  been  propofed,  and  have  experience  alledged  to 
vouch  for  their  efficacy  ;  but  many  doubts  (till  remain 
with  refpect  to  this :  and  though  I  cannot  determine 
in  this  matter  from  my  own  experience,  I  think  it  in- 
cumbent on  me  to  give  the  beft  judgment;  I  can  form 
with  refpeft  to  the  choice  of  the  remedies  at  prefenj: 
recommended. 

MDXXVF. 

I  am,  in  the  firft  place,  firmly  perfuaded,  that  the 
mod  certain  means  of  preventing  the  conferences 
of  the  bite,  is  to  cut  out,  or  otherwife  deilroy,  the  part 
in  which  the  bile  has  been  made.  In  this  every  body 
agrees  ;  but  with  this  difference,  that  fome  are  of  opi- 
nion that  it  can  only  be  effectual  when  it  is  done  very 
foon  after  the  wound  has  been  made,  and  they  there- 
fore neglecl  it  when  this  opportunity  is  miffed.  There 
have  been,  however,  no  experiments  made  proper  to 
determine  this  matter :  and  there  are  many  confidera- 
tions  which  lead  me  to  think,  that  the  poifon  is  not 
immediately  communicated  to  the  fyftern ;  and  there- 
fore, that  this  meafure  of  deftroymg  the  part  may  be 
pra&ifed  with  advantage,  even  many  days  after  the 
bite  has>  been  given. 

MDXXVIL 

Whilit  the  dale  of  our  experience,  with  refped:  to 
feveral  remedies  now  in  ufe,  is  uncertain,  I  cannot 
venture  to  affert  that  any  of  thefe  is  abfolutely  inef- 
fectual ;  but  I  can  give  it  as  my  opinion,  that  the  effi- 
cacy of  mercury,  given  very  largely,  and  perfiited  in 
for  a  long  time,  both  as  a  means  of  prevent  ing  the 

diieafe,, 


256  PRACTICE 

difeafe,  and  of  curing  it  when  it  has  aftually  come  on, 
is  better  fupported  by  experience  than  that  of  any 
other  remedy  now  propofed  or  commonly  employed. 


BOOK        IV. 

O    F 

V      E       S       A       N      I       JE,- 

OR     OF      THE 

DISORDERS    OF    THE    INTELLECTUAL 
FUNCTIONS. 

CHAP.        I. 
OF     V  E  S  A  N  I  JE    IN     GENERAL. 

MDXXVIII. 

THE  Nofologifls,  Sauvages  and  Sagar,  in  a  clafs  of 
difeafes  under  the  title  of  VFSANIJE,  have  com- 
prehended the  two  orders,  of  Hallucinationcs  or  Falfe 
Perceptions,  and  of  Morojitates  or  Erroneous  Appe- 
tites and  Paflions  ;  and,  .in  like  manner,  Linnaeus  in 
his  clafs  of  MENTALES,  correfponding  to  the  Vefaniae 
of  Sauvages,  has  comprehended  the  two  orders  of  Ima- 
ginarii  and  Patbetici,  nearly  the  fame  with  the  Hallu- 
cinationes  and  Morojitates  of  that  author.  This,  how- 
ever, from  ieveral  confederations,  appears  to  me  im- 
proper ;  and  I  have  therefore  formed  a  clafs  of  Vefa- 
niae  nearly  the  fame  with  the  Paranoias  of  Vogel,  ex- 
cluding 


O  F    P  H  Y  S  I  C.  257 

eluding  from  it  the  Hallucinationes  and  Morofitates, 
which  I  have  referred  to  the  Morbi  Locales.  Mr. 
Vogel  has  done  the  like,  in  feparating  from  the  Para- 
noias the  falfc  perceptions  and  erroneous  appetites  ; 
and  has  thrown  thefe  into  another  clafs,  to  which  he 
has  given  the  title  of  Hyperaefiefes. 
MDXXIX. 

It  is  indeed  true,  that  certain  hallucinationes  and 
rnorofitiites  are  frequently  combined  with  what  I 
propofe  to  coniider  as  flriclly  a  vefania  or  an  errone- 
ous judgment  ;  and  fometimes  the  hallucinationes 
feem  to  lay  the  foundation  of,  and  to  form  almoft  en- 
tirely, the  vefania.  But  as  mod  part  of  the  halluci- 
nationes enumerated  by  the  Nofologifls  are  affections 
purely  topical,  and  induce  no  other  error  of  judgment 
belide  that  which  relates  to  the  fmgle  object  of  the 
fenfe  or  particular  organ  affected ;  fo  thefe  are  certain- 
ly to  be  feparated  from  the  difeaies  which  confift  in  a 
more  general  affection  of  the  judgment.  Evert  when 
the  hallucinationes  conilantly  accompany  or  feem  to 
induce  the  vefania,  yet  being  fuch  as  arife  from  inter- 
nal caufes,  and  may  be  prefumed  to  arife  from  the 
fame  caufe  as  the  more  general  affection  of  the  judg- 
ment, they  are  therefore  to  be  confidered  as  fymptoms 
of  this  only. 

In  like  manner  I  judge  with  refpect  to  the  moron*- 
tates,  or  erroneous  paffions,  that  accompany  vefania  ; 
which,  as  confequences  of  a  falfe  judgment^  mullbe 
considered  as  arifing  from  the  fame  caufes,  and  as 
fymptoms  only,  of  the  more  general  affection. 

There  is,  indeed,  one  cafe  of  a  morofuas  which 
feems  to  induce  a  vefania,  or  more  general  affection  of 
the  judgment ;  and  this  may  lead  us  to  coniider  the 
vefania,  in  this  cafe,  as  a  fymptom  of  an  erroneous 
appetite,  but  will  not  afford  any  good  reafon  for  com- 
prehending the  morofitates  in  general  under  the  vefa- 
ice,  confidered  as  primary  difeafes. 

VOL,  II.  K  k  The 


-5$                   F  R  A  C  T  I  C  E 

The  re,  of  the  chfs  of  Vtfanire 

to  t'  V  lajulty,  ieems  from  eveiy 
[o 

ilar  clilV  be  cofrifcenehds-d  under 


this  '     '<';ing  as'  they  af- 

iecl  or  fteeping.     Thcfe 

again  bs  eoqfidered,  as 

in  an  erroneous  judgment,  to  which  I  (hall 

:  :ji  of  Delirium  ;  or  as  they  confiit  in 

a  \Yi.  lion  bf  judgment,  which  I  fhali 

;i  \vith  the  cohiideratiofl  of  DC- 


v 

/i s  men  cliifer  greatly  in  the  foundnefs  and  force  cf 
their  judgment ,  io   it  n  proper  here  to  aicertain 

more  pr  what  e  ror  or  imperfection  of  our  judg- 

:is  morbi-.l,  and  to  ad- 
-irium  and  fatuity.     In 

;;,    1  ihall  firii:  coniider  the  morbid  errors  of 
judgment  under  tr.  -iation  of  Delirium, 

has  been  co  cd  to  denote  every 

mode  of  fucb  eh 

As  our  i  "it  :"  chicfiv  exerc::ed  in    difcerning 

and  ju^  the  fever al  relations  of  things,   1  ap-- 

pre!  :tt   delirium   may  be   defined  to  be, — In  a 

p-rfcn  asvake,  a  falfe  or  rnifhken  judgment  of  thufe 
relations  of  things,  which  as  occurring  moil  frequent- 
ly in  life,  are  thofe  about  which  the  generality  cf 
men  form  the  feme  judgment ;  and  particularly  when 
the  judgment  is  very  diilcTer;t  from  what  the  peribn 
himieif  had  before  ufually  formed. 
MDXXXII. 

With  this  miftaken  judgment  of  relations  there  is 
frequently  joined  fome  falfe  perception  of  external  ob- 
jects, without  any  evident  fault  in  the  organs  of  fcnfe, 
and  which  ieems  therefore  to  depend  upan  the  imagi- 
nation 


.OFF  H.Y  S  I  C.  259 

nation,  aiiiing  from  a  c  i  in  th '  b  'ain  ; 


or  an  erronc 
as  the  diYeafj. 

M   •  II. 

Another  circuimfla   , 
urn,  is  a  very  uir 

refpcci  to  mod  of  r.he  atlairs  or  corn 
laid 'up  in  the  memory  are,  in  rn     [ 
the  fame  manner-;  fo  a  v 
individual,    mull  p  v 

i.'ioii  foi  adatiori  of  : 

therefore  this  in;-  iy  Iiu 

n  of  ideas,  .  -  coi 

I 


IVIDXXXIV. 

A  third'circum'.'  d  liriu 

tion  or  p.idion,  I          ; 
the  timid  kind 
tion  or  ju   ,-.    :   :it5  it  is  p"op 

ther  in  /  to  the  peril  n 

himfelf,  icr  i 

other  men. 

i>  ,!;*(„  .,  < : 


f 


Ou,— 

ons  of  i  ,  ••  ai.,n,   ai.d 

CDnimon'v  ions, 

Sucii  dthriuin  is  of  ;  as  it  is  c 

vr,  us  it  is  en- 
..   ^  tirely 


26o  PRACTICE 

tirely  without  any  fuch  combination.  It  is  the  latter 
cafe  that  we  name  Infanity  ;  and  it  is  this  kind  of  de- 
lirium onlv  that  I  am  to  treat  of  here. 

MDXXXVI. 

Infanity  may  perhaps  be  properly  confidered  as  a 
genus  comprehending  many  different  fpecies,  each  of 
which  may  deferve  our  attention;  but  before  proceedr 
ing  to  the  confideration  of  particular  fpecies,  I  think 
it  proper  to  attempt  an  inveftigation  of  the  caufe  of 
infanity  in  general. 

MDXXXVII. 

In  doing  this,  I  mall  take  it  for  granted,  as  demon- 
flrated  elfcwhere,  that  although  this  difeafe  feems  to 
be  chiefly,  and  fometimes  folely,  an  affection  of  the 
mind  ;  yet  the  connection  between  the  mind  and  bo- 
dy in  this  cafe  is  fuch,  that  thefe  affections  of  the  mind 
mud  be  confidered  as  depending  upon  a  certain  ftate 
of  our  corporeal  part.  See  Halleri  Prim.  Lin.  Phy- 
lio.  log.  §  DLXX.  See  Boerhaavii  Inft.  Med. 
S  DLXXXI.  pcxcvi. 

MDXXXVIII. 

Admitting  this  propoiition,  I  mud  in  the  next  place 
afTurne  another,  which  I  like  wife  fuppofe  to  be  demon- 
ftrated  cife  where.  This  is,  that  the  part  of  our  body 
•more  immediately  connected  with  the  mind,  and 
therefore  more  efpeciarlly  concerned  in  every  affection 
of  the  intellectual  functions,  is  the  common  organ  of 
the  nerves  ;  which  I  fhnll,  in  what  follows,  fpeak  of 
under  the  appellation  of  the  Brain. 
MDXXXIX. 

Here,  however,  in  arTummg  this  Lift  proportion,  a 
very  great  difficulty  immediately  prefents  itfelf.  Al- 
though we  cannot  doubt  that  the  operations  of  our  in- 
tellect always  depend  upon  certain  motions  taking 
place  in  the  brain,  (fee  Gaub.  Path.  Med.  §  523;) 
vet  thefe  motions  have  never  been  the  objects  of  our 
fenfes,  nor  have  we  been  able  to  perceive  that  any  par- 
ticular 


OF     PHYSIC. 

ticular  part  of  the  brain  has  more  concern  in  the  ope* 
rations  of  our  intellect  than  any  other.  Neither  have 
we  attained  any  knowledge  of  what  fhare  the  feveral 
parts  of  the  brain  have  in  that  operation ;  and  there- 
fore, in  this  iicuation  of  our  fcience,  it  mud  be  a  very 
difficult  matter  to  difcover  thole  ftatcs  of  the  brain 
that  may  give  occaiion  to  the  various  (late  of.  our  intcl- 
Jedual  functions. 

MDXL. 

It  may  be  obferved,  that  the  different  date  of  the 
motion  of  the  blood  in.  the  veflels  of  the  brain  has 
fome  fhare  in  affecting  the  operations  of  the  intellect : 
andphyncians,  in  feeking  for  the  caufes  of  the  differ- 
ent (tares  of  our  intellectual  functions,  have  hardly 
looked  further  than  into  the  (late  of  the  blood,  or  into 
the  condition  of  the  blood  itfelf :  but  it  is  evident  that 
the  operations  of  the  intellectual  functions  ordinarily 
go  on,  and  are  often  considerably  varied,  without  our 
being  able  to  perceive  any  difference  either  in  the  mo- 
tions or  in  the  condition  of  the  blood. 

MDXLI. 

Upon  the  other  hand,  it  is  very  probable  that  the 
ftate  of  the  intellectual  functions  depends  chiefly  upon 
the  Itate  and  condition  of  what  is  termed  the  Nervous 
Power,  or,  as  we  fuppofe,  of  a  fubtile  very  moveable 
fluid,  included  or  inherent,  in  a  manner  we  do  not 
clearly  underftand,  in -every  part  of  the  medullary  fub- 
(lance  of  the  brain  and  nerves,  and  which  in  a  living 
and  healthy  man  is  capable  of  being'  moved  from  eve- 
ry one  part  to  every  other  of  the  nervous  fvftem. 

iMDXLH. 

With  refpcct  to  this  power,  we  have  pretty  clear 
proof  that  it  frequently  has  a  motion  from  the  fentient 
extremities  of  the  nerves  towards  the  brain,  and  there- 
by produces  fenfarion  ;  and  we  have  the  fame  proof, 
that  in  confequence  of  volition  the  nervous  power  has 
a  motion  from  the  brain  into  the  mufcles  or  organs 

of 


•262  PRACTICE 

of  motion.  Accordingly,  as  fenfation  excites  our  in- 
tellectual operations,  and  volition  is  the  effect  of 
"-_',  lui-.l  as  the  connection  between  fenfation  and 
volition  is  always  by  the  intervention  of  the  brain  and 
c/  intellectual  operations;  fo  we  can  hardly  doubtv 
thr.t  thefe  iarr.er  depend  upon  certain  motions,  and 
the  various  modification  of  ihefs  motions,  in  the 
brain. 

JXLIII. 

To  afcertam  tlie  ci'lcrcnt;  itates  of  thefe  motions 
may  be  very  diillcuit  ;  and  pbyficians  h;;vc  commonly 
confider^d  it  to  be  fo  very  nfipvfterious,  that  they  have 
g-.:HL'ra-iy  despaired  of  attaining  any  knowledge  v 
regard  to  it ;  but  I  confider  fuch  ahiblute  defpair,  and 
the  negligence  it  iflfpires,  to  be  always  very  blamea- 
ble  ;  and  I  fhall  now  venture  to  go  fbme  length  in  the 
inquiry,  hoping  that  forne  fteps  made  with  tolerable 
iirmnefa  e  ucs  to  go  It  ill  further. 

MDXLIV. 

To  this  purpofc,  I  think  it  evident,  that  the  nervous 
power,  in  the  whole  as  well  as  in  the  nervous  fyflem, 
and  particularly  in  the  brain,  is  at  different  times  in 
different  degrees  of  mobility  and  force.  To  thefe  dif- 
ferent flatcs,  1  beg  leave  to  apply  the  terms  ^Excite- 
ment wdColIapfe.  To  that  date  in  which  the  mobili- 
ty and  force  are  fufficientfor  the  exercifc  of  the  func- 
tions, or  when  thefe  Hates  are  any  way  preternatural-1 
]y  increafed,  I  give  the  name  (A  Excitement  j  and  to 
that  llatein  whuih  the  mobility  and  force  are  not  fuf- 
ficient  iur  the  ordinary  exercifc  of  the  functions,  »  r 
when  they  are  diminiihed  from  the  (late  in  which  they 
had  been  before,  I  give  the  narne  of  Collapfe.  1  beg, 
however,  it  may  be  obfervid,  tnat  by  tliefe  terms  I 
mean  to  exprefs  marter-  only  ;  and  wiiLoiit  in- 

tending, by  thcf.:  rerms,  lo  expLiin  the  clrcurnf:::' 
or  condition  inical,  of  the  nc:  r  or  flu- 

id in  thci'j  dirTerent  Uate:. 

MDXLV. 


OF      PHYSIC.  263 

MDXLV. 

That  thefe  different:  ftates  of  excitement  ana  colhpfe 
take  place  on  different  occaiions,  mull,  I  think,  be 
rnaniieil  from  numbcrlefs  phenomena  of  the  animal 
cecohomy  :  but  it  is  especially  to  our  prefent  purpofe 
to  obfcrve,  that  the  different  ftates  of  excitement  and 
collapfe,  are  in  no  inftance  more  remarkable,  than  in 
the  different  dates  of  waking  and  ileeping.  In  the 
latter,  when  quite  complete,  the  motion  and  mobili- 
ty of  the  nervous  power,  with  refpeclc  to  the  whole  of 
what  are  called  the  Animal  Functions,  eiiiir.ly  ceafe, 
or,  as  I  would  exprefs  it,  are  in  a  (late  of  cciL:pu;;  and 
are  very  different  from  the  itata  of  waking,  which  in 
healthy  perfons  I  would  call  a  Hate  of  general  and 
entire  excitement. 

MDXLVI. 

This  difference  in  thefLu. .:•;  >f  the  nervous  power  in 
fleeping  and  waking  being  admitted,  I  muffc  in  the 
next  place  obferve,  that  when  thefe  dates  are  changed 
from  the  one  into  the  other,  as  cornnipnly  happens 
every  day,  the  change  is  hardly  ever  made  inftantane- 
oufiy,  but  almoft  always  by  degrees,  and  in  forne 
length  of  time  only  :  and  this  may  be  obferved  with 
refpecl  to  both  fenfe  and  motion.  Thus  when  a  per- 
fcn  is  falling  afleep,  the  feniibility  is  gradually  dimi- 
niihcd :  fo  that,  although  fome  degree  of  fleep  has 
come  on,  flight  impreflions  will  excite  fenfation,  and 
bring  back  excitement;  v/hich  tie  fame,  or  even 
flronger  impreilinns,  will*  be  insufficient  to  product 
when  the  Tcate  of  fieep  has  continued  U^n^er,  and  i?, 
ns  \ve  may  lay,  more  complete.  In  like  manner,  the 
power  of  voluntary  motion  is  gradually  diminished. 
Jn  fome  members  it  fails  fooner  than  in  others  ;  and  it  is 
iome  time  before  it  becomes  general  and  confiderablc 
over  the  whcle. 

The  fame  gradual  prog  re  fs  may  be  remarked  in  a 
perfon's  coming  out  of  fieep  :  The  ears  in  this  caft  are 

oh  en 


264  ?'  R  A  C  T  I  G  E 

often  awake  before  the  cy£s  are  opened  or  fee  clearly, 
and  the  fenfes  are  often  awake  before  the  power  of 
voluntary  motion  is  recovered  ;  and  it  is  curious  to 
cbferve,  that,  in  fome  cafes,  fenfations  may  be  excited 
without  producing  the  ordinary  ailociation  of  ideas. 
See  Mem,  de  Berlin.  1752. 

MDXLVII. 

From  all  this,  I  think  it  will  clearly  appear,  that  not 
only  the  different  flares  of  excitement  and  collapfe  can 
take  place  in  different  degrees,  but  that  they  can 
take  place  in  different  parts  of  the  brain,  or  at  leaft^ 
with  refpectto  the  different  functions,  in  different  de- 
grees. 

As  I  prefume  that  almoft  every  perfon  has  perceived 
the  gradual  approach  of  ileeping  and  waking,  i  like- 
"Vvife  fuppofe  every  perfon  has  obferved,  that,  in  fuch 
intermediate  date  of  unequal  excitement,  there  almoft 
always  occurs  more  or  lefs  of  delirium,  or  dreaming, 
if  any  body  choofes  to  call  it  fo.  There  are  in  this 
flate  falfe  perceptions,  falfe  afibciations,  falfe  judg- 
ments, and  difproportionate  emotions  ;  in  morn,  alt 
the  circuiriiiances  by  which  I  have  above  defined  deli- 
rium. 

This  clearly  mows  chat  delirium  may  depend,  and 
I  mail  hereafter  endeavour  to  prove  that  it  commonly 
does  depend  upon  fome  inequality  in  the  excitemenc 
of  the  brain  ;  and  that  both  thefe  aiTertions  are  found- 
ed on  this,  that,  in  order  to  the  proper  exercifc 
of  our  intellectual  functions,  the  excitement  muft  be 
complete,  and  equal  in  every  part  of  the  brain.  For 
though  we  cannot  fay  that  the  vefliges  of  ideas  are 
laid  up  in  different  parts  of  the  brain,  or  that  they  are 
in  fome  meafure  diffufed  over  the  whole,  it  will  follow 
upon  either  fuppofuion,  that  as  our  re:ifoning  our  in- 
tellectual  operatior;,  always  require  the  orderly  and  ex- 
ad  recollection  or  memory  of  aflbciatcd  ideas ;  fo,  if 
any  part  of  the  brain  is  not  excited,  or  not  excitable, 

that: 


O  F     P  H  Y  S  I  C.  265 

that  recollection  c:nnct  properly  take  place,  while  at 
the  lame  time  other  parts  of  the  brain,  more  excited 
and  excitable,  may  give  falie  perceptions,  aiibciaticns, 
and  judgments. 

MDXLVIII. 

It  will  ferve  to  illufirate  this,  that  the  collapfe  in 
fleep  is  more  or  lefs  complete  ;  or  that  the  fleep,  as 
we  commonly  fpeak,  is  more  or  lefs  profound ;  and 
therefore,  that  in  many  cafes,  though  fleep  takes  place 
to  a  considerable  degree,  yet  certain  impreffions  do 
fail  take  effect,  and  excire  motions,  or,  if  you  will, 
fenfations  in  the  brain  ;  but  which  fenfations,  upon 
account  of  the  collapfed  fcare  of  fo  great  a  part  of  the 
brain,  are  generally  of  the  delirious  kind,  or  dreams, 
confirming  of  falfe  perceptions,  aiTociations,  and  judg- 
ments, that  would  have  been  corrected  if  the  brain  had 
been  entirely  excited. 

Every  one,  I  believe.)  has  obfervcd,  that  the  moft 
imperfect  fleeps,  are  thofe  chiefly  attended  with  dream- 
ing ;  that  dreams,  therefore,  moffc  Commonly  occur 
towards  morning,  when  the  complete  Hate  of  fleep  is 
paiimg  away  ;  and  further,  that  dreams  are  mod  com- 
monly excited  by  ilrong  and  uneafy  imprcffions  made 
upon  the  body. 

1  apprehend  it  may  alfo  be,  an  illuflration  of  the 
-fame  thing,  that,  even  in  waking  hours,  we  have  an 
inflance  of  an  unequal  (late  of  excitement  in  the  brain 
producing  delirium,  Such,  1  think,  occurs  in  the 
cafe  of  fever,  In  this  it  is  maniferl,  that  the  energy 
of  the  brain,  or  its  excitement,  is  considerably  dirni- 
niliied  with  refpecl  to  the  animal  functions  :  and  it  is 
accordingly  upon  this  ground  that  I  have  explained 
above,  in  XLV.  the  delirium  which  fo  commonly  at- 
tends fever.  To  what  1  have  there  fa  id  tl  fhall  here 
only  add,  that  it  may  ferve  to  confirm  my  doctrine, 
that  the  delirium  in  fever  corhes  on  at  a  certain  period 
of  the  difeafe  only,  and  that  we  can  commonly  dSfc'Irii 

VOL.  II.  L  1 


266  PRACTICE 

its  approach  by  a  more  than  ufual  degree  of  it  appear- 
ing in  the  time  of  the  patient's  falling  into  or  coming 
out  of  ileep.  It  appears,  therefore,  that  delirium, 
when  it  full  conies  on  in  fever,  depends  upon  an  ine- 
quality of  excitement ;  and  it  can  hardly  be  doubted, 
that  the  delirium  which  comes  at  length  to  prevail  in 
the  entirely  weakened  ftate  of  fevers,  depends  upon 
the  fame  caufe  prevailing  in  a  more  confiderable  de- 
gree. 

MDXLIX. 

From  what  has  been  now  delivered,  I  hope  it  will 
be  iuiticicntly  evident,  that  delirium  may  be,  and  fre* 
quently  is,  occafioned  by  an  inequality  in  the  excite- 
ment of  the  brain. 

How  the  different  portions  of  the  brain  may  at  the 
fame  time  be  excited  or  collapled  in  different  degrees, 
or  how  the  energy  of  the  brain  may  be  in  different  de- 
grees offeree,  with  refpe&tothe  ieveral  animal,  vital, 
and  natural  functions,  I  cannot  pretend  to  explain  ; 
but  it  is  fufficiently  evident  in  fact,  that  the  brain 
may  be  at  one  and  the  fame  time  in  different  conditi- 
ons with  refpect  to  thefe  functions.  Thus  in  inflam- 
matory difeafes,  when  by  a  flimulus  applied  to  the 
brain  the  force  of  the  vital  functions  is  preternaturally 
increafed,  that  of  the  animal  is  either  little  changed, 
or  coniiderable  diminiihed.  On  the  contrary,  in  ma- 
ny cafes  of  mania,  the  force  of  the  animal  functions 
depending  always  on  the  brain,  is  prodigicuily  increaf- 
ed, while  the  fcate  of  the  vital  function  in  the  heart  is. 
very  little  or  not  at  all  changed.  I  muft  therefore  fay 
again,  that  how  difficult  foever  it  may  be  to  explain 
the  mechanical  or  phyfical  condition  of  the  brain 
in  fuch  cafes,  the  facts  are  fufficient  to  ihow  that  there 
is  fuch  antinequality  as  may  diiturb  our  intellectual 
operations. 

MDL. 

I  have  thus   endeavoured    to  explain  the  general 

caufe 


O  F    P  H  Y  S  I  C.  267 

caufe  of  Delirium;  which  is  of  two  kinds  :  according 
as  it  is  with,  or  without,  pyrexia.  Or  the  fird  I  take 
no  further  notice  here,  havjng  explained  it  as  well  as 
I  could  above  in  XLV. 

I  proceed  now  to  confider  that  delirium  which  pro- 
perly belongs  to  the  clafs  of  Vefaniss,  and  which  I 
ihall  treat  of  under  the  general  title  of  Infant  ty. 

MDLI. 

In  entering  upon  this  fubjed,  it  immediately  occurs, 
that  in  many  inllances  of  infinity,  we  find,  upon  dif- 
fedlion  after  death,  that  peculiar  ciroumfiances  had 
taken  place  in  the  general  condition  of  the  brain.  In 
many  cafes,  it  has  been  found  of  a  drier,  harder,  and 
firmer  confidence,  than  what  it  is  ufually  of  in  per- 
ions  who  had  not  been  affected  with  that  difenfe.  In 
ether  cafes,  it  has  been  found  in  a  more  humid,  foft, 
and  flaccid  fiate  ;  and  in  the  obfervations  of  the 
late  Mr.  Meckel*,  it  has  been  found  conlklerably 
changed  in  its  denfity  or  fpecific  gravity.  Whether 
thefe  different  ftates  have  been  obferved  to  be  uni- 
formly the  fame  over  the  whole  of  the  brain,  I  cannot 
certainly  learn  ;  and  I  fufpect  the  cii  (lectors  have  nor 
always  accurately  inquired  into  this  ci  re  u  in  fiance  : 
but  in  feverai  inilances,  it  appears  that  thefe  dates  had 
been  different  in  different  parts  of  the  brain  ;  and  in- 
flances  of  this  inequality  will  afford  a  confirmation  of 
our  general  doctrine. 

The  accurate  Morgagni  has  obferved,  that  in  mani- 
acal perfons  the  medullary  portion  of  the  brain  is  un- 
ullully  dry,  hard,  and  firm  :  And  this  he  had  fo  fre- 
quently obferved,  that  he  was  difpofed  to  confider  ic 
as  generally  the  cafe.  But  in  moil  of  the  particular 
inflances  which  he  has  given,  it  appears,  that,  for  the 
moll  part,  while  the  cerebrum  was  of  an  uiiufually 
hard  and  firm  confidence,  the  cerebellum  was  of  its 

LI  2  llfuitl 


n  pourmMce  ly/}-.        f    appeare      n  many 

inftanccs  of  infane  perfons,  that  the  rr.edulktry  fubltancc  of  the  cere- 
brum was  drier,  and  of  a  iefi'  fpecific  gravity,  t!iau  in  perfons  who 
hxd  been  always  ofa  fourx!j«og?r.ent, 


2*63  PRACTICE 

iifual  foftnefs  :  and  in  many  of  the  cafes  it  was  unfa- 
ally  foft  and  flaccid.  In  fome  other  cafes,  Morgagni 
obferves,  that  while  a  part  of  the  .cerebrum  was  hard- 
er and  firmer  than  ordin%ry,  other  parrs  of  it  were 
:. rurally  foft. 

MDLII. 

Thefe  obArrvations  tend  to  confirm  our  general  doc^ 
trine  :  and  there  are  others  which  I  think  will  apply 

pofe, 

the         '    tlon  of  the  bodies  of  perfons  who 
had  -'.1  under  infanity,  various  organic  affe&ions 

had  been  dil  .'  in  p-.i;ticular  parts  of  the  brain  ; 

and  it  is  :'u  .c:  itiy  n-.'j,.:-u.>ie,  that  ftich  organic  ak 
feclions  niiyjit  lu^e  produced  a  different  degree  of 
excite nen r  free  and  affected  parts,  and  rnuil 

j<J  in  loLiie  meafure  the  free  communi- 
cai:-  ~een  the  fever al  parts  of  the  brain,  and  in 

e  occaiioned  uifanityi 

There  have  -,cciUTed  lo  many  iniiances  of  this 
that  I  believe  phyficians  are  gcneraiiy  difpofed  to  u,!- 
fpe.^1:    Or'^anic  lefions   of  the  brain  to  exiu  ir^almpft 
every  cafe  ofiijfanity. 

MDLI1I. 

This,  however,  is  probably  a  miftak^  :  f  >r  we  know] 
that  there  have  bo  ;ices  of  ;  m  ivhicrl 

the  perfons  have  entirely  recovered;  and  it  is 
to  fuppofe  that  any  organic  lefions  of  the  brain  h; 
fuch  calc  taken  place.     Such  traniitory  caics,  iiu 
render  it  probable,  that  a  tlate  of  excitcmcn:5  ch,. 

;  by  various  caufes,  hcid  been  the  caufe  of  fuch  in* 
ilauceb  of  hilarity. 

MDLIV. 

It  is  indeed  fur}.  -"ted,   that,  in  many  in  lances 

of  iniV;  -''.u  had  b  tied  i-iVr 

death,  tg  that,  ai  Ic  leii-oiis  haq 

before  (ubillled  in  th'c  bm;  :t  miy  - 

bid  ftateof.the  brain  ;.  .  ..  • 

mai 


OF     PHYSIC.  269 

mav  ferve  to  fliow,  that  organic  lefions  had  not  been, 
the'caufe  of  the  difeafe  ;  but  it  does  not  allure  us  that 
no  morbid  change  had  taken  place  in  the  brain  :  for  it 
is  probable,  that  the  directors  were  not  always  aware 
of  its  being  the  general  condition  of  hardnefs  and  den- 
iity,  as  different  in  different  parts  of  the  brain,  true 
\vas  to  be  attended  to,  in  order  to  difcover  the  catife  of 
the  preceding  difeafe  ;  and  therefore  many  of  them 
had  not  with  this  view  examined  the  (late  of  the  brain, 
as  Morgagni  feems  carefully  to  have  done. 

:  MDLV. 

Having  thus  endeavoured  to  inveiTIgate  the  caufe 
of  infinity  in  general,  it  were  to  be  wiihed  that  I  could 
apply  the  doclrine  to  the  the  fever al 

fpccies  of  it,  according  as  they  :  n  the  differ- 

cnt  (late  and  circumftances  of  In,  and  thereby 

to  the  e  (tab  ii  fhing  of  a  fcicntific  and  accurately7  adapted 
ineihod  of  eyre.  Thefe  purpofes,  however,  appear  to 
me  to  be  extremely  difficult  to  be  attained  ;  and  I  can- 
not hope  to  execute  them  here.  All  I  can  do  is  to 
make  fame  attempts,  and  offer  fome  inflections  which 
further  obfervation  and  greater  fagucky,  may  hereaf- 
ter render  more  ufeful. 

MDLVI. 

The   ingenious  Dr.  Arnold  has  been  cor-  bly 

employed  in  diftinguifhing  the  dltferc  f  iri- 

\ianity  as  they  appear  with  relpec:  to  the  mind  ;  and 
his  labours  may  hereafter  prove  ufeful,  when  we  fhall 
come  ro  know  ibmething  more  of  the  difFerent  (lutes  of 
the  brain  correfponding  to  thefe  different  fiates  of  the 
mind;  but  at.  prefcnt  1  can  make  little  application  of 
his  numerous  diilincllons  It  r.ppc:irs  to  me  that  he 
has  chiefly  pointed  out  and  enumerated  diilinctions, 
t.;:at  are  merely  varieties,  which  can  lead  to  little  or 
no  variety  of  practice  :  and  I  arn  efpecially  led  to  form 

s  the  Litter  concluiion,  becaufe  thefe  varieties  appear  to 
me  to  be  often  coinbiruxd  togeth^r^and  to  be  often 

changed 


370  PRACTICE 

changed  into  one  another,  in  the  fame  perfon ;  in 
whom  we  muft  therefore  fuppofe  a  general  caufe  of 
the  difeafe,  which,  fo  far  as  it  can  be  known,  miifl 
etlabliih  the  pathology,  and  cfpecially  direcl  the  prac- 
tice. 

MDLVIL 

In  my  limited  views  of  the  different  ftates  of  infani- 
ty,  I  rnuil  go  on  to  confider  them  under  the  two  heads 
of  Mania  and  Melancholia:  and  though  I  am  fenfible 
th;;t  thefe  two  genera  do  not  comprehend  the  whole 
of  the  fpecies  of  infinity,  I  am  not  clear  in  affigning 
the  other  fpecies  which  may  not  be  comprehended 
under  thcfc  titles.  I  lhall,  however,  endeavour,  on 
r-roper  occnfions,  as  I  go  along,  to  point  them  out  as 
well  as  I  can. 


C     II     A     P.         II. 
OF -MANIA,  OR  MADNESS. 

MDLVI1I. 

'HE  circumftsrnces  which  I  have  mentioned  above 
in  MDXXXV.  as  conflituting  delirium  in  general, 
GO  more  efpeci:iily  belong  to  that  kind  of  it  which  I 
lhall  treat  of  here  under  the  title  of  MANIA. 

There  is  fometimes  a  faife  perception  or  imagination 
of  things  prcfent  that  are  not ;  but  this  is  not  a  con- 
fiant,  nor  even  a  frequent.,  attendant  of  the  difeafe. 
The  falfe  judgment,  is  of  relations  long  before  laid  up 
in  the  memory.  It  very  often  turns  upon  one  fmgle 
fubjecl ;  but  more  commonly  the  mind  rambles  from 
one  fubjecl:  to  another  with  an  equally  falfe  judgment 

con- 


O  F    P  H  T  S  I  C.  271 

concerning  the  mod  part  of  them  ;  and  as  at  the  fame 
time  there  is  commonly  a  falfe  affociation,  this  increaf- 
es  theconfuilon  of  ideas,  and  therefore  the  falfe  judg- 
ments.     What  for  the  moil  part  more  efpecially  dif- 
unguimes  the  difeafe  is   a  hurry  of  mind,  in  purfuing 
any  thing  like  a  train  of  thought,  and  in  running  from 
one  train  of  thought  to  another.      Maniacal  perfons 
are  in  general  very  irafcible;  but  what  more  particu- 
larly produces   their  angry  emotions    is,    that   their 
falfe  judgments  lead  to  fome  action  which  is   al ways 
pufhed  with  impettiofity  and  violence  ;  when  this  is 
interrupted  or  reftrained,   they  break  out  into  violent 
anger  and  furious  violence  againft  every  perfon  near 
them,  and  upon  every  thing  that  (lands  in  the  way  of 
their  impetuous  will.     The  falfe  judgment  often  turns 
upon  a   miflaken  opinion  of  fome  injury  fuppofed    to 
have  been  formerly  received,  or  now  fuppofed  to  be 
intended  :  and  it  is  remarkable,  that  fuch  an  opinion 
is  often  with  refpeft  to  their  former  dearetl  friends  and 
relations  ;  and   therefore    their  refentmcnt  and  anger 
are  particularly  directed  towards  thefe.    And  although 
this  ihould  not  be  the  cafe,  they  commonly  foon  lofe 
that  refpecl  and   regard   which  they  formerly  had  for 
their  friends  and  relations.     With   all   thefe  circum- 
flances,  it  will  be  readily  perceived,   that    the   difeafe 
mud  be  attended  very  conftantly  with  that  incoherent 
and  abfurd  fpeech  \ve  call  raving.     Further,  with  the 
circumftances  mentioned,  there  is  commonly  joined  an 
unufual  force  in  all  the  voluntary    motions  ;  and  an 
infenfibility  or  refinance  of  the  force  of  all  impreffi- 
ons5  and  particularly  a  relillance  of  the  powers  of  ilecp, 
or  cold,,  and  even  of  hunger  ;  though  indeed  in  ma- 
ny inftances  a  voracious  appetite  takes  place. 

MDL1X. 

It  appears  to  me  that  the  whole  of  thefe  circum- 
ftances and  fymptorns  point  out  a  considerable  and  un- 
ufual excefs  in  the  excitement  of  the  brain,  efpecially 

with 


272  PRACTICE 

with  refpeft  to  the  animal  functions  ;  and  it  appears 
at  the  fame  time  to  be  manifefiiy  in  Tome  meafure  un- 
equal, as  it  very  often  takes  place  with  refpecl  tothefe 
'functions  alone,  while  at  the  fame  time  the  vital  and 
natural  are  commonly  very  little  changed  from  their 
ordinary  healthy  fiate. 

MDLX. 

How  this  excels  o?  exciien.^nt  is  produced,  it  may 
be  difficult  to  ex-plain.  In  tl  :;ces  of 

what  Salivates  has  named  t  :;cilca,  and 

in  all  the  infLinccs  I  have  mention-id  in  my  Nofo! 
under  the  title  of  the  Mania  Corpprea^  it  may  be  fuppof-- 
ed  that  a  morbid  organic  affection  is  produced  in  lorae 
part  of  the  brain  ;  and  how  that  may  produce  sn  in- 
created  or  unequal  excitement  in  certain  parts  of  it,  I 
have  endeavoured  to  explain  above  in  MDLII.  But  I 
mufr  at  the  fame  time  acknowledge,  that  fuch  remote, 
caufcs  of  mania  have  very  rarely  occurred  ;  and  that 
'therefore  fome  other  caufes  of  the  difeafe  mull  be 
fought  for. 

The  effects  of  violent  emotions  or  paffions  of  the 
mind  have  more  frequently  occtired  as  the  remote 
caufes  of  mania ;  and  it  is  iiifficiently  probable,  that 
fuch  violent  emotions,  as  they  do  often  immediately 
produce  a  temporary  increafe  of  excitement,  fo  they 
may,  upon  ic.rns  cccaficns  of  their  permanent  inhe- 
rence or  frequent  repetition,  produce  a  more  cor.ii- 
derable  and  more  permanent  excitement,  that  is,  a 
mania. 

"With  refpecl  to  thofe  caufes  of  mania  which  arife  in 
confequence  of  a  melancholia  which  had  previoufty 
long  lubfiiled  ;  \vhether  we  confrler  that  melancholia 
as  a  partial  i;  or  us  n  loi;;.r  perilling  attachment  to 

one  train  of  thinking,  it  will  be  readily  perceived,  that 
in  either  cafe  fuch  an  increafe  of  excitement  may  take 
place  in  fo  confiderable  a  degree,  and  in  fb  la;  ere  a 

,  i  lion 


O  F    P  H  Y  S  I  C.  273 

portion  of  the  brain,  as  may  give  occafion  to  a  complete 
mania. 

MDLXI. 

Thefe  confiderations  with  regard  to  the  remote 
caufes  appear  to  me  to  confirm  fufficiently  our  general 
doctrine  of  increafed  and  unequal  excitement  in  the 
mania  which  I  have  defc^ibed  above  ;  but  I  mud  own 
that  I  have  not  exhaufted  the  fubjecr,  and  that  there 
are  cafes  of  mania  of  which  1  cannot  affign  the  remote 
caufes :  but  although  I  cannot  in  all  cafes  explain  in 
what  manner  the  mania  is  produced,  I  prefume,  from 
the  explanation  given,  and  efpecially  from  the  fymp- 
toms  enumerated  above,  to  conclude,  that  the  dif- 
eafe  defcribed  above  depends  upon  an  increafed  ex- 
citement of  the  brain  ;  an  opinion  in  which  I  am  the 
more  confirmed,  as  I  think  it  will  point  out  the  proper 
method  of  cure.  At  leail  I  think  it  will  mofl  clearly 
explain  the  operation  of  thofe  remedies,  which,  fo  far 
as  I  can  learn  from  my  own  experience  and  that  of 
others,  have  proved  the  mofl  fuccefsful  in  this  difeafe  ; 
and,  to  iliuftrate  this,  I  now  enter  upon  the  confidera- 
tion  of  thefe  remedies,  and  to  make  feme  remarks  upon 
the  proper  manner  of  employing  them. 
MDLXII. 

Reftraining  the  anger  and  violence  of  rfladmen  is 
always  neceffary  for  preventing  their  hurting  them- 
felves  or  others  :  but  this  reftraint  is  alib  to  be  confi- 
dercd  as  a  remedy.  Angry  paflions  are  always  ren- 
dered more  violent  by  the  indulgence  of  the  impetu- 
ous motions  they  produce  ;  and  even  in  madmen  the 
feeling  of  reftraint  will  fometimes  prevent  the  efforts 
which  their  paffion  would  otherwife  occafion.  Re- 
ftraint, therefore,  is  ufeful,  and  ought  to  be  complete  ;. 
but  it  fliould  be  executed  in  the  eafieft  manner  pofli- 
ble  for  the  patient,  and  the  (trait  waiftcoat  anfwers  eve- 
ry purpofe  better  than  any  other  that  has  yet  bet-n. 
thought  of.  The  reftraining  madmen  by  the  force  of 

VOL.  II.  M  m  other 


274  PRACTICE 

other  men,  as  occafioning  a  conftant  flruggle  and  vio- 
lent agitation,  is  often  hurtful.  Although,  on  many 
occalions,  it  may  not  be  fafe  to  allow  maniacs  to  be 
upon  their  legs  or  to  walk  about,  it  is-  never  definable 
to  confine  them  to  a  horizontal  fituation  ;  and  whene- 
ver it  can  be  admitted,  they  Should  be  more  or  lefs  in 
an  erect  pofture.  Although  there  may  be  no  fymp- 
toins  of  any  preternatural  fulnefs  or  increafed  impetus- 
of  blood  in  the  veffels  of  the  brain,  a  horizontal  pof- 
ture always  increafes  the  fulnefs  and  terfion  of  thefe 
veifcls,  and  may  thereby  increafe  the  excitement  of 
the  brain. 

MDLXIII. 

The  reftraint  mentioned  requires  confinement  with- 
in doors,  and  it  ihould  be  in  a  place  which  prefents  as 
few  objects  of  fight  and  hearing  as  pcffible ;  and  par- 
ticularly, it  mould  be  removed  from  the  objects  that 
the  patient  was  formerly  acquainted  with,  as  thefe 
would  more  readily  call  up  ideas  and  their  various  aflb- 
ciations.  it  is  for  this  reafon  that  the  confinement  of 
madmen  fhould  hardly  ever  be  in  their  ufual  habita- 
tion;  or  if  they  are,  that  their  apartment  fhould  be 
flripped  of  all  its  former  furniture.  It  is  alfo  for  the 
mofl  part  proper,  that  maniacs  ihould  be  without  the 
company  of  any  of  their  former  acquaintance  ;  the  ap- 
pearance of  whom  commonly  excites  emotions  that 
increafe  the  difeafe.  Strangers  may  at  fait  be  often- 
five  ;  but  in  a  little  time  they  come  to  be  objects  either 
of  indifference  or  of  fear,  and  they  fhould  not  be  fre- 
quently changed. 

MDLXIV, 

Fear  being  a  pafTion  that  diminishes  excitement, 
may  therefore  be  oppofed  to  the  excefs  of  it ;  and 
particularly  to  the  angry  and  irafcible  excitement  of 
maniacs.  Thefe  being  more  fufceptible  of  fear  than 
might  be  expected,  it  appears  to  me  to  have  been 
commonly  ufeful.  In  moft  cafes  it  has  appeared  to 

be 


OF    PHYSIC.  275 

be  neceflary  to  employ  a  very  conflant  impreffion  of 
fear;  and  therefore  to  infpire  them  \virh  the  awe  and 
dread  of  fome  particular  perfons,  efpecially  of  thofe 
who  are  to  be  conftamly  near  them.  This  awe  and 
dread  is  therefore,  by  one  means  or  other,  to  be  ac- 
quired ;  in  the  firft  place,  by  their  being  the  authors 
of  all  the  reftraints  that  may  be  occasionally  proper ; 
but  foinedmes  it  may  be  neceflary  to  acquire  it  even 
by  fhipes  and  blows.  The  former,  although  having 
the  appearance  of  more  feverity,  are  much  fafer  than 
ftrokes  or  blows  about  the  head,  Neither  of  them, 
however,  mould  be  employed  further  than  ftems  ve- 
ry neceflary,  and  mould  be  truitcd  only  to  thofe  whofe 
difcretion  can  be  depended  upon.  There  is  one  cafe 
in  which  they  are  fuperfluous ;  that  is,  when  the  ma- 
niacal rage  is  either  not  fufceptible  of  fear,  or  incapa- 
ble of  remembering  the  objects  of  it;  for 'in  inch  in- 
ilances,  ftripes  and  blows  would  be  wanton  barbarity. 
In  many  cafes  of  a  moderate  difeafe,  it  is  of  advantage 
that  the  perfons  who  are  the  authors  of  reflraint  and 
punifhment  fhould  be  upon  other  occafions  the  be- 
flowers  of  indulgence  and  gratification  that  is  admif- 
fible  ;  never,  however,  neglecting  to  employ  their 
"awe  when  their  indulgence  ihali  have  led  to  any 
abufe. 

MDLXV. 

Although  in  mania,  no  particular  irritation  nor  ful- 
nefs  of»the  fyftem  feem  to  be  preterit,  it  is  plain,  that 
the  avoiding  all  irritation  and  means  of  fulnefsis  pro- 
per ;  arid  therefore,  that  a  diet  neither  ftimuiating 
nor  nourifhing  is  commonly  to  be  employed.  As  it 
may  even  be  ufeful  to  diminiih  the  fulnefs  <<f  the  fyf- 
tem  fo  both  a  low  and  a  fparc  diet  is  likely  in  moll  ca^ 
ies  to  be  of  fervice. 

MDT.XVI. 

Upon  the  fame  principle,  although  no  unufual  ful- 
ncis  of  rue  body  be  preient,  it  may  be  of  advantage 

M  in  z  'to 


276  PRACTICE 

to  diminifh  even  its  ordinary  fulnefs  by  different  eva- 
cuations. 

Blood-letting,  in  particular,  might  be  fuppofed  ufe- 
ful ;  and  in  all  recent  cafes  of  mania  it  has  been  com- 
rnonly  praclifed,  and  I  think  with  advantage  ;  but 
•when  the  difeafe  has  fubiifted  for  fome  time,  I  have 
feldom  found  blood-letting  of  fervice.  In  thofe  in- 
Itances  in  which  there  is  any  frequency  or  fulnefs  of 
pulfe,  or  any  marks  of  an  increafed  impetus  of  the 
blood  in  the  veiTels  of  the  head,  blood- letting  is  a  pro- 
per and  even  a  ncceirary  remedy.  Some  practitioners, 
in  fuch  cafes,  have  preferred  to  a  particular  manner  of 
blood-letting,  recommending  arteriotomy,  fcarifying 
the  hind-head,  or  opening  the  jugular  vein  ;  and 
where  any  fulnefs  or  inflammatory  difpofir.ion  in  the 
yeffels  of  the  brain  is  to  be  fufpecled,  the  opening  of 
the  veiTels  nearer!  to  them  is  likely  to  be  of  the  great- 
cit  fervice.  The  opening,  however,  of  either  the 
temporal  artery  or  the  jugular  vein  in  maniacal  per- 
fons  is  very  often  inconvenient ;  and  it  may  generally 
be  fufficient  to  open  a  vein  in  the  arm,  while  the  body 
is  kept  in  fomewhat  of  an  eredl  pofture,  and  fuch  a 
quantity  of  blood  drawn  as  nearly  brings  on  a  deliqui- 
um  anirni,  which  is  always  a  pretty  certain  mark  of 
Ibme  diminution  of  the  fulnefs  and  tenlion  of  the  vei- 
fels  of  the  brain. 

MDLXVII. 

For  the  fame  purpofe  of  taking  off  the  fulnefs  and 
teniion  of  thefe  veilels  of  the  brain,  purging  may  be 
employed  ;  and  I  can*  in  no  other  view  underftand 
the  celebrated  ufc  of  hellebore  among  the  ancients.  I 
cannot,  however,  fuppcfe  any  fpecitic  power  in  helle- 
bore ;  and  can  by  no  means  find  that,  at  leaft  the 
black  hellebore,  is  fo  efficacious  with  us  as  it  is  faid  to 
have  been  at  Anticyra.  As  coflivenefk,  however,  is 
commonly  a  very  conftanc  and  hurtful  attendant  of 
mania,  purgatives  come  to  be  fometirnes  very  nccef- 

fary; 


O  1<       PHYSIC.  277 

fary  ;  and  I  haye  known  fome  benefit  obtained  from 
the  frequent  ufe  of  pretty  draflic  purgatives.  In  this, 
however,  I  have  been  frequently  difappointed  ;  and  I 
have  found  more  advantage  from  the  frequent  ufe  of 
cooling  purgatives,  particularly  foluble  tartar,  than 
from  more  draftic  medicines. 

MDLXVIII. 

Vomiting  has  alfo  been  frequently  employed  in  ma- 
nia; and  by  determining  powerfully  to  the  furface  of 
the  body,  it  may  poffibly  diminish  the  fulnefs  and 
tenfion  of  the  velfels,  and  thereby  the  excitement  of 
the  brain  ;  but  I  have  never  carried  the  ufe  of  this  re- 
medy fo  far  as  might  enable  me  to  judge  properly  of 
its  eifecls.  Whether  it  may  do  harm  by  impelling 
the  blood  too  forcibly  into  the  veliels  of  the  brain, 
'or  whether  by  its  general  agitation  of  the  whole  fyf- 
tem  it  may  remove  that  inequality  cf  excitement 
which  prevails  in  mania,  I  have  not  had  experience 
enough  to  determine. 

MDLXIX. 

Frequent  (having  of  the  head  has  been  found  offer- 
vice  in  mania,  and  by  promoting  perfpiration  it  pro- 
bably takes  off  from  the  excitement  of  internal  parts. 
This,  however,  it  is  likely,  may  be  more  effectually 
done  by  bliftering,  which  more  certainly  takes  off  the 
excitement  of  fubjaccnt  parts.  In  recent  cafes  it  has 
been  found  ufeful  by  inducing  fleep  ;  and  when  it  has 
that  effect,  the  repetition  of  it  may  be  proper  :  but  in 
maniacal  cafes  that  have  laded  for  fome  time,  blifter- 
ing has  not  appeared  to  me  to  be  of  any  fervice  ;  and 
in  fuch  cafes  alfo  I  have  not  found  perpetual  bliflers, 
or  any  other  form  of  ifllie,  prove  ufeful. 
MDLXX. 

As  heat  is  the  principal  means  of  firft  exciting  the 
nervous  fyfiein,  and  eitablifhing  the  nervous  power 
and  vital  principle  in  animals  ;  fo,  in  cafe  of  preterna- 
tural exckement,  the  application  cf  cold  might  be 

iuppoJtd 


273  PRACTICE 

fuppofed  a  proper  remedy  :  but  there  are  many  inftan- 
ces  of  maniacs  who  have  been  expofed  for  a  great 
length  of  time  to  a  confiderable  degree  of  cold  with- 
out having  their  fymptoms  any  wife  relieved.  This 
may  render  in  general  the  application  of  cold  a  doubt- 
ful remedy  ;  but  it  is  at  the  fame  time  certain,  that 
maniacs  have  often  been  relieved,  and  fomethnes  en- 
tirely cured,  by  the  ufe  of  cold  bathing,  efpecially 
when  adrniniftered  in  a  certain  manner.  This  feems 
to  confift,  in  throwing  the  madman  in  the  cold  wa- 
ter by  furprife  ;  by  detaining  him  in  it  for  fome  length 
of  time;  and  pouring  water  frequently  upon  the  head, 
while  the  whole  of  the  body  except  the  head  is  im- 
inerfed  in  the  water  ;  and  thus  managing  the  whole 
procefs,  ib  as  that,  with  the  affiitance  of  fome  fear,  a 
refrigerant  efFecl:  may  be  produced.  This,  I  can  af- 
firm, has  been  often  ufeful ;  and  that  the  external  ap- 
plication of  cold  may  be  of  fervice,  we  know  further 
from  the  benefit  which  has  been  received  in  fome  ma- 
niacal cafes  from  the  application  of  ice  and  fnow  to 
the  naked  head,  and  from  the  application  of  the  not- 
td  Clay  Clap. 

Warm  bathing  alfo  has  been  recommended  by 
fome  practical  writers  ;  and  in  forne  rigid  melancholic 
habits  it  may  poliibly  be  ufefuJ,  or  as  employed  in 
the  manner  prefcribed  by  fome,  of  immerling  the  low- 
er parts  of  the  body  in  warm  water,  while  cold  water 
aired  upon  the  head  and  upper  parts.  Of  this 
practice,  however,  I  have  had  no  experience,  and  in 
the  common  manner  of  employing  warm  bathing  I 
have  found  it  rather  hurtful  to  maniacs. 

MDLXXI. 

rcording  to  my  fuppofition   that  the   difeafe  de~ 
•3  upon  an  inereaied  excitement  of  the   brain,   e- 
•allv  with  refped  to  the  animal  functions,  opium, 
io  commonly  powerful  in  inducing  deep,   or  a  confi- 
derable colhpie  as  to  thefe  functions,    fhouJd  be    a 

powerful 


OF    PHYSIC,  279 

powerful  remedy  of  mania.  That  it  has  truly  proved 
fuch,  I  believe  from  the  tedimony  of  Bernard  Huet, 
whofe  practice  is  narrated  at  the  end  of  Wepferi  Hif- 
toria  Apopleclicorum.  I  leave  to  my  readers  to  ftudy 
this  in  the  work  I  have  referred  to,  where  every  part 
of  the  practice  is  fully,  and  it  appears  to  me,  very  ju- 
dicioufly  delivered.  I  have  never  indeed  carried  the 
trial  ib  far  as  feems  to  be  requtiite  to  an  entire  cure  : 
but  I  have  frequently  employed  in  fome  maniacal  caf- 
es large  dofes  of  opium ;  and  when  they  had  the  effect: 
of  inducing  fleep,  it  was  maniferlly  with  advantage. 
At  the  fame  time,  in  fome  cafes,  from  doubts,  whe- 
ther the  difeafe  might  not  depend  upon  fome  organic 
leiions  of  the  brain,  when  the  dpiurn  would  be  fuper- 
fluoos  ;  and  mother  cafes,  from  doubts,  whether  there 
might  not  be  fome  inflammatory  affection  joined  with 
the  mania,  when  the  opium  would  be  hurtful,  I  have 
never  puihed  this  remedy  to  the  extent  that  might  be 
neceffary  to  make  an  entire  cure. 
MDLXXII. 

Camphi)  e  has  been  recommended  as  a  remedy  of 
mania,  and  there  are  inftances  alledged  of  its  having 
performed  an  entire  cure.  As  it  appears  from  the  ex- 
periments of  Beccaria  that  this  fubilance  js  polfeiTed 
of  a  fedative  and  narcotic  virtue,  thefe  cures  are  not 
altogether  improbable:  butinfeveral  trials,  and  even 
in  large  dofes,  I  have  found  no  benefit  from  it ;  and 
excepting  thofe  in  the  PhilofophicalTranfacHons,  N°. 
400.  I  have  hardly  met  with  any  other  teilimonies  in 
its  favour. 

MDLXXTIL  ' 

I  have  been  informed  that  fome  maniacs  have  been 
cured  by  being  compelled  to  conftant  and  even  hard 
labour ;  and  as  a  forced  attention  to  the  conduct  of 
any  bodily  exercife  is  a  vrry  certain  means  of  divert- 
ing the  mind  from  purfuing  any  train  of  thought,  it  is 

highly 


28o  PRACTICE 

highly  probable  that  fuch  exercife  may  be  ufeful  in 
many  cafes  of  mania. 

I  muft  conclude  this  fubjecl  with  obferving,  that  e- 
ven  in  feveral  cafes  of  complete  mania  I  have  known 
a  cure  take  place  in  the  courfe  of  a  journey  carried  on 
for  fome  length  of  time. 

MDLXXIV. 

Thefe  are  the  remedies  which  have  been  chiefly 
employed  in  the  mania  that  has  been  above  defcrib- 
ed5  and  I  believe  they  have  been  employed  promifcu- 
ouQy  without  fuppoling  that  the  mania  \vas  to  be  dif- 
tinguifhecl  into  different  fpecies.  Indeed  I  am  not 
ready  to  fay  bow  far  it  is  to  be  fo  diftinguifhed,  but  I 
ihall  offer  one  observation  which  may  poiiibly  merit 
attention. 

It  appears  to  me  that  there  are  two  different  cafes  of 
mania  that  are  efpecially  different  according  to  the  ori- 
ginal temperament  of  the  pCrfons  whom  the  difcafe 
affects.  It  perhaps  occurs  mod  frequently  in  perfons 
of  a  melancholic  or  atrabilarian  temperament ;  but  it 
certainly  does  alfo  often  occur  in  perfons  of  that  very 
opposite  temperament  which  phylicians  have  named 
the  Sanguine.  According  as  the  difeafe  happens  to 
occur  in  perfons  of  the  one  or  other  of  thefe  tempera- 
ments I  apprehend  it  maybe  coniidered  as  of  a  differ- 
ent nature ;  and  I  believe,  that  accurate  obfervation, 
employed  upon  a  fufficient  number  of  cafes,  would  dif- 
cern  fome  pretty  conftant  difference,  either  of  the 
fymptoms,  or  at  lead  of  the  ftate  of  fymptoms,  in  the 
two  cafes.  I  imagine  that  falfe  imaginations,  particu- 
lar averfions  and  refentments,  are  more  fixed  and  Hea- 
dy in  the  melancholic  than  in  the  fanguine  ;  and  that 
fomewhat  inflammatory  is  more  commonly  joined 
\vith  mania  in  the  fanguine  than  in  the  melancholic. 
If  fuch  difference,  however,  does  truly  take  place,  ic 
\vill  be  obvious,  that  it  may  be  proper  to  make  fome 
difference  alfo  in  the  practice.  I  am  opinion,  that  in 

the 


OF     PHYSIC.  281 

the  mania  of  fanguine  perfons,  blood-letting  and  other 
antiphlogiftic  meafures  are  more  proper,  and  have  been 
more  ufeful,  than  in  the  melancholic.  I  likewife  ap- 
prehend that  cold  bathing  is  more  ufeful  in  the  fan- 
guine than  in  the  melancholic  :  but  I  have  not  had  ex- 
perience enough  to  afcertain  thefe  points  with  fuffici- 
ent  confidence. 

I  have  only  to  add  this  other  obfervation,  that  ma- 
niacs of  the  fanguine  temperament  recover  more  fre- 
quently and  more  entirely  than  thofe  of  the  melancho- 
lic. 


CHAP.       III. 

OF  MELANCHOLY  AND  OTHER  FORMS 
OF    INSANITY. 

MDLXXV. 

MELANCHOLY  has  been  commonly  confidered 
as  a  partial  infanity  ;  and  as  fuch  it  is  defined 
in  my  Nofology  :  but  I  now  entertain  doubts  if  this  be 
altogether  proper.  By  a  partial  infanity,  I  undcrftartd 
a  falfe  and  miftaken  judgment  upon  one  particular  fub- 
je&,  and  what  relates  to  it ;  whilft,  on  every  other 
fubjecl,  the  perfon  affeded  judges  as  the  generality  of 
other  men  do.  Such  cafes  have  certainly  occurred  ; 
but,  I  believe,  few  in  which  the  partial  infanity  is  flricl- 
ly  limited.  In  many  cafes  of  general  infanity,  there 
is  one  fabjecT:  of  anger  or  fear,  upon  which  the  falfe 
judgment  more  particularly  turns,  or  which  is  at  lead 
more  frequently  than  any  other  the  prevailing  objecl: 
of  delirium  :  and  though,  from  the  inconfiftency  which 
this  principal  objecl:  of  delirium  muft  produce,  there 
VOL.  II.  N  n  is 


232  PRACTICE 

is  therefore  alfo  a  great  deal  of  infinity  with  regard 
to  mod  other  objects  ;  yet  this  iaft  is  in  very  diiTc 
degrees,  both  in  different  perfons,  and  in  the  fame  per- 
fon  at  different  limes.  Thus  perfons  coufidered  as  ge- 
nerally ihfane,  will,  however,  at  times,  and  in  ionic 
cafes,  pretty  conftantly  judge  properly  enough  of  prc- 
lent  cifcumftances  and  incidental  occurrences;  though, 
•when  thefe  objects  engaging  attention  are  not  pre- 
fented,  the  operations  of  imagination  may  readily 
bring  back  a  general  confufion,  or  rccal  the;  particular , 
object  of  the  delirium.  From  thefe  considerations,  I 
am  inclined  to  conclude,  that  the  limits  between  ge- 
neral and  partial  infanity  cannot  always  be  fo  exactly 
aifigned,  as  to  determine  when  the  partial  affection  is 
to  be  confidered  as  giving  a  peculiar  fpecies  of  difeafe, 
different  from  a  more  general  infanity. 

MDLXXVI. 

When  infanity,  neither  ftrictly  partial,  nor  entirely 
nor  conftantly  general,  occurs  in  perfons  of  a  fanguirie 
temperament,  and  is  attended  with  agreeable,  rather 
than  with  angry  or  gloomy  emotions,  I  think  fuch  a 
difeafe  muft  be  conlidered  as  different  from  the  Ma- 
nia defcribed  above  :  and  alfo,  though  partial,  mufl 
be  held  as  different  from  the  proper  Melancholia  to 
be  mentioned  hereafter. 

MDLXXV1I. 

Such  a  difeafe,  as  different  from  thofe  defcribed  M- 
DLIV.  requires,  in  my  opinion,  a  different  adminiftra- 
tion  of  remedies ;  and  it  will  be  proper  for  me  to  take 
particular  notice  of  this  here. 

Although  it  may  be  neceffary  to  reft  rain  fuch  infane 
perfons  as  we  have  mentioned  MDLXXVJ.  from  purfu*. 
ing  the  objects  of  their  falfe  imagination  or  judgment, 
it  will  hardly  be  requilite  to  employ  the  fame  force 
of  reitraint  that  is  neceifary  in  the  impetuous  and  an- 
gry mania.  It  will  be  generally  fufficient  to  acquire 
ibme  awe  over  them*  that  may  be  employed,  and 

iome  times 


O  F    P  H  Y  S  I'C.  283 

fometimes  even  be  neceffary,   to   check  the  rambling 
of  their  imagination,  and  incoherency  of  judgment. 
MDLXXV1II. 

The  reftraint  juft  now  mentioned  as  neceffary  will 
generally  require  the  patient's  being  confined  to  one 
place,  for  the  fake  of  excluding  the  objects,  and  more 
particularly  the  perfons,  that  might  excite  ideas  con- 
nefted  with  the  chief  objects  of  their  delirium.  At 
the  fame  time,  however,  if  it  can  be  perceived  there 
are  objeds  or  perfons  that  can  call  off  their  attention 
from  the  purfuit  of 'their  own  difordered  imagination, 
and  fix  it  a  little  upon  fome  others,  thefe  laft  may  be 
frequently  presented  to  them :  and  for  this  reafon,  a 
journey,  both  by  its  having  the  effect  of  interrupting 
all  train  of  thought,  and  by  prefenting  objects  engag- 
ing attention,  may  often  be  ufefuL  In  fuch  cafes  al- 
fo,  when  the  inianity,  though  more  efpecially  fixed 
upon  one  mi  (taken  f  abject,  is  not  confined  to  this 
alone,  but  is  further  apt  to  ramble  over  other  fubjects, 
with  incoherent  ideas,  I  apprehend  the  confining  or 
forcing  fuch  perfons  to  fome  conftant  uniform  labour^ 
may  prove  an  uieful  remedv. 

MDLXXIX. 

When  fuch  cafes  as  in  MDLVI.  occur  in  fanguine 
temperaments,  and  may  therefore  approach  more 
nearly  to  Phrenitic  Delirium  ;  fo,  in  proportion  as  the 
fymptoms  of  this  tendency  are  more  evident  and  con~ 
iiderable,  blood-letting  and  purging  will  be  the  more 
proper  and  necelTary. 

MDLXXX. 

To  this  fpecies  of  infanity,  when  occurring  in  fan- 
guine temperaments,  whether  it  be  more  or  lefs  parti- 
al, I  apprehend  that  cold  bathing  is  particularly  a- 
dapted;  while,  in  the  partial  infanity  of  melancholic 
perfons,  as  I  fhall  mow  hereafter,  it  is  hardly  admiffi- 
ble. 

Q  2  MBLXXXI. 


284  PRACTICE 

MDLXX^XL 

Having  thus  treated  of  a  ipecies  of  infanity,  differ- 
ent, in  my  apprehenfion,  from  both  the  Mania  and 
Melancholia,  I  proceed  to  confider  what  feems  more 
properly  to  belong  to  this  laft. 

MDLXXXII. 

The  difeafe  which  I  name  Melancholia  is  very  oft- 
en a  partial  infanity  only.  But  as  in  many  inftances, 
though  the  falfe  imagination  of  judgment  feems  to  be 
with  refpect  to  one  iubject  only  ;  yet  it  feldom  happens 
that  this  does  not  produce  much  inconfiftency  in  the 
other  intellectual  operations  :  And  as,  between  a  ve- 
ry general  and  a  very  partial  infanity,  there  are  all  the 
poflible  intermediate  degrees ;  fo  it  will  be  often  diffi- 
cult, or  perhaps  improper,  to  diftinguifh  melancholia 
by  the  character  of  Partial  Infanity  alone.  If  I  mil- 
take  not,  it  mull  be  chiefly  diftinguifhed  by  its  occur- 
ring in  perfons  of  a  melancholic  temperament,  and  by 
its  being  always  attended  with  foine  feemingly  ground- 
lefs,  but  very  anxious,  fear. 

MDLXXXIIL 

To  explain  the  caufe  of  this,  I  mud  obferve,  that 
perfons  of  a  melancholic  temperament  are  for  the  mo  ft 
part  of  a  ferious  thoughtful  difpofition,  and  difpofed 
TO  fear  and  caution,  rather  than  to  hope  and  temerity. 
Perfons  of  this  cad  are  lefs  inoveable  than  others  by 
any  impreffions  ;  and  are  therefore  capable  of  a  clofer 
or  more  continued  attention  to  one  particular  object, 
or  train  of  thinking.  They  are  even  ready  to  be  en- 
gaged in  a  conftant  application  to  one  f abject ;  and 
are  remarkably  tenacious  of  whatever  emotions  they 
happen  to  be  affected  with. 

MDLXXXIV. 

Thefe  circumftances  of  the  melancholic  character, 
feem  clearly  to  mew,  that  perfons  ftrongly  affected 
with  it  may  be  readily  feized  with  an  anxious  fear  ; 
and  that  this,  when  much  indulged,  us  is  natural  to 

fuch 


OF      PHYSIC.  285 

fuch  perfons,  may  eafily  grow  into  a  partial  infanity. 

MDLXXXV. 

Fear  and  d  ejection  of  mind,  or  a  timid  and  defpond- 
ing  difpolition,  may  arife  in  certain  Rates,  or  upon  cer- 
tain occafions  of  mere  debility  :  and  it  is  upon  this 
footing,  that  I  fuppofe  itfometimes  to  attend  dyfpep- 
lia.  But  in  thefe  cafes,  I  believe  the  defpondent  dif- 
pofition  hardly  ever  arifes  to  a  confiderable  degree,  or 
proves  fo  obftinately  fixed  as  when  it  occurs  in  per- 
ilous of  a  melancholic  temperament.  In  thefe  lail,  al- 
though the  fear  proceeds  from  the  fame  dyfpeptic 
feelings  as  in  the  other  cafe,  yet  it  will  be  obvious, 
that  the  emotion  may  arife  to  a  more  confiderable  de- 
gree ;  that  it  may  be  more  anxious,  more  fixed,  and 
morq  attentive  ;  and  therefore  may  exhibit  ail  the  va- 
rious circurnitances  which  I  have  mentioned  in  ?/rcc- 
xxii.  to  take  place  in  the  difeafe  named  KYPOCITON- 

DRIAS1S. 

MDLXXXVI. 

In  considering  this  fubjecl  formerly  in  diftinguifliing 
Dyfpepfia  from  Hypochondriacs,  although  the  fymp- 
coms  affecting  the  body  be  very  much  the  fame  in 
both,  and  even  thofe  affecting  the  mind  be  force  what 
iimilar,  I  found  no  difficulty  in  diftinguiihirtg  the  lat- 
ter difeafe,  merely  from  its  occurring  in  perfonj  of  a 
melancholic  temperament,  But  I  nluil  no w  acknow- 
ledge, that  I  am  at  a  lots  how  to  determine  in  all  caf- 
es hypochondriacs  and  melancholia  may  be  ciiftin- 
guiilied  from  one  another,  whilft  the  fam  era- 

meat  is  common  to  both. 

MDLXXXVII. 

I  apprehend,  however,  that  the  diftindtton  may  be 
generally  afcertained  in  the  following   manner. 

The  hypochondriafis  I  v/ould  confider  being  al- 
ways attended  with  dyfpeptic  fymptoms  :  and  tlioi^h 
there  may  be,  at  the  fame  time,  an  anxious  melancho- 
lic fear  arifing  from  the  feeling  of  thefe  fymptoms; 


286  PRACTICE 

yet  while  this  fear  is  only  a  miftaken  judgment  with 
refpecT:  to  the  ftate  of  the  perfon's  own  health,  and  to 
the  danger  to  be  from  thence  apprehended,  I  would 
ilill  confiderthe  difeafe  as  hypochondriacs,  and  as  dif- 
tinct  from  the  proper  melancholia.  But  when  an  anx- 
ious fear  and  defpondency  arifes  from  miftaken  judg- 
ment with  refpecl:  to  other  circumftances  than  thofe  of 
health,  and  more  efpecially  when  the  perfon  is  at  the 
fame  time  without  any  dyfpeptic  fymptoms,  every 
one  will  readily  allow  this  to  be  a  difeafe  widely  dif- 
ferent from  both  dyfpepiia  and  hypochondriafis ;  and 
it  is,  what  I  would  ftridly  name  Melancholia. 
MDLXXXV1IL 

In  this  there  feems  little  difficulty  ;  but  as  an  exqui- 
iltely  melancholic  temperament  may  induce  a  torpor 
Jind'  flownefs  in  the  action  of  the  fiomach,  io  it  gene- 
rally produces  fome  dyfpeptic  fymptoms ;  and  from 
thence  there  may  be  fome  difficulty  in  diftinguifhing 
fuch  a  cafe  from  hypochondriacs.  But  I  would  main* 
tain,  however,  that  when  the  characters  of  the  tem- 
perament nreftrongly  marked  ;  and  more  particularly 
\vhen  the  falie  imagination  turns  upon  other  fubjects 
than  that  of  health,  or  when,  though  relative  to  the 
performs  own  body,  it  is  of  a  groundlefs  and  abfurd 
kind  ;  then,  notwithstanding  the  appearance  of  fome 
dyfpeptic  fymptoms,  the  cafe  is  flili  to  be  confide  red 
KS  that  of  a  melancholia,  rather  than  a  hypochondri- 
afis. 

MDLXXXIX. 

The  difeafe  of  melancholia,  therefore  manifeflly 
depends  upon  the  general  tt  rnperament  of  the  body  : 
and  although,  in  many  peribns,  this  temperament  is 
not  attended  with  any  morbid  afFeftion  either  of  mind 
or  body  ;  yet  when  it  becomes  exquiiitdy  formed, 
and  is  in  a  high  degree,  it  may  become  a  difeafe  affect- 
ing both,  and  particularly  the  mind.  It  will  therefore 
be  proper  to  confider  in  what  this  melancholic  tcmpc- 

rament 


OF    PHYSIC.  287 

rament  efpecially  confifts ;  and  to  this  purpofe,  it  may 
be  obferved,  that  in  it  there  is  a  degree  of  torpor  in 
the  motion  of  the  nervous  power,  both  with  refpect  to 
feniation  and  volition  ;  that  there  is  a  general  rigidity 
of  the  iimple  folids  ;  and  that  the  balance  of  the  fan* 
guiferous  fyflem,  is  upon  the  lide  of  the  veins.  BuC 
ftll  thefe  circumftances  are  the  directly  oppoiiteof  thofe 
of  the  fangujpe  temperament ;  and  muft  therefore  alfo 
produce  an  oppofite  ftate  of  mind. 

MDXC. 

It  is  this  ftate  of  the  mind,  and  the  (late  of  the  brain 
correfponding  to  it,  that  is  the  chief  object  of  our  pre- 
fent  confideration.  But  what  that  Hate  of  the  brain 
is,  will  be  fuppofed  to  be  difficult  to  explain  $  and  it 
may  perhaps  ieem  ram  in  me  to  attempt  it. 

1  will,  however,  venture  to  fay,   that  it  is  probable 
the  melancholic  temperament  of  mind  depends  upon 
a  drier  and  firmer  texture  in  the  medullary  fubflance 
of  the  brain  ;  and  that  this  perhaps  proceeds   from    a 
certain  want  of  fluid  in  that  fubftance,  which  appears 
from  its  being  of  a   lefler  fpecific  gravity  than  ufual. 
That  this  itate  of  the  brain  in  melancholia  does  actu- 
ally cxift,  I  conclude,  firjt,    from  the  general  rigidity 
of  the  whole  habit ;  and,  fecondly,   from  difledlions, 
fhowing  fuch  a  flate  of  the  brain  to  have  taken  plar.e 
in  mania,  which  is  often  no  other  than  a  higher  degree 
of  melancholia:     It  does  not  appear  to  me  anywifs 
difficult   to  fuppofe,    that  the  fume  ftate  of  the  brain 
may  in  a  moderate  degree  give  melancholia ;  and  in 
a  higher,  that  mania  which  melancholia  fo  often  pafTes 
into  ;  efpecially  if  I  (hall  be  allowed  further  vo  fuppofe, 
that  either  a  greater  degree  of  nrmneis  m  die  fubftance 
of  the  brain  may  render  it  iufceptible  of  a  higher  de- 
gree of  excitement,  or  that  one  portion  of  the  brain 
may  be  liable  to  acquire  a  greater  firmnefs  than  others, 
and  confequently  give   occafion  to  that  inequality    of 
excitement  upon  which  mania  fo  much  depends. 

MDXCI 


PRACTICE 

MDXCI. 

I  have  thus  endeavoured  to  deliver  what  appears  t® 
me  moft  probable  with  reipect  to  the  proximate  caufe 
of  melancholia;  and  although  the  matter  faould  in 
fome  refpe&s  remain  doubtful,  I  am  well  perfuaded 
that  thefe  obfervations  may  often  be  employed  to  di- 
rect our  practice  in  this  diicafe,  as  I  fhall  now  endea- 
vour to  mow. 

MDXCIL 

In  moil  of  the  inftances  of  melancholia,  the  mind 
is  to  be  managed  very  much  in  the  fame  manner  as  I 
have  advifed  above  with  regard  to  hypochondriacs ; 
but  as  in  the  cafe  of  proper  melancholia,  there  is  com- 
monly a  falfe  imagination  or  judgment  appearing  as  a 
partial  infanity,  it  may  be  further  ncceffary  in  fuch 
cafes  to  employ  fome  artifices  for  correcting  fuch  ima- 
gination or  judgment. 

MDXCIII. 

The  various  remedies  for  relieving  the  dyfpeptic 
fymptoms  which  always  attend  hypochondriacs,  will 
feldom  be  either  requifite  or  proper  in  melancholia. 

There  is  only  one  of  the  dyfpeptic  fymptoms,  which, 
though  there  mould,  be  no  other,  is  very  conitantly 
prelent  in  melancholia,  and  that  is  coftivenefs.  This 
it  is  always  proper  and  even  neceifary  to  remove  ;  and 
I  believe  it  is  upon  this  account  that  the  ufe  of  purga- 
tives has  been  found  fo  often  ufeful  in  melancholia. 
Whether  there  be  any  purgatives  peculiarly  proper  in 
this  cafe,  I  dare  not  pofitively  determine  ;  but  with 
refpecl  to  the  choice  of  purgatives  in  melancholia,  I 
am  of  the  fame  opinion  that  I  delivered  above  on  this 
famefubjecl:  with  refpecl  to  mania. 
MDXCIV. 

With  refpecl  to  other  remedies,  I  judge  that  blood- 
letting will  more  feldom  be  proper  in  melancholia  than 
in  mania  ;  but  how  far  it  may  be  any  in  cafe  proper, 

mufl 


O  F    P  H  Y  S  I  G.  289 

muft  be  determined  by  the  fame  consideration  as  in 
the  cafe  of  mania. 

MDXCV. 

The  cold  bathing  that  I  judged  to  be  fo  very  ufe- 
ful  in  fcveral  cafes  of  infanity,  is,  I  believe,  in  melan^ 
cholia,  hardly  ever  fit  to  be  admitted  ;  at  leaft  while 
this  is  purely  a  partial  affection,  and  without  any 
marks  of  violent  excitement.  On  the  contrary,  upon 
account  of  the  general  rigidity  prevailing  in  melan- 
cholia, it  is  probable  that  warm  bathing  may  be  often 
ufeful. 

MDXCVL 

With  refpecl:  to  opiates  which  I  have  fuppofed 
might  often  be  ufeful  in  cafes  of  mania,  I  believe 
they  can  feldom  be  properly  employed  in  the  partial 
infanities  of  the  melancholic,  except  in  certain  inftanc-* 
es  of  violent  excitement,  when  the  melancholia  ap- 
proaches nearly  to  the  ftate  of  mania. 
MDKCVil. 

In  fuch  cafes  of  melancholia  approaching  to  a  flat® 
of  mania,  a  low  diet  may  fometimes  be  neceffary  ;  but 
as  the  employing  a  low  diet  almoft  unavoidably  leads 
to  the  ufe  of  vegetable  food,  and  as  this  in  every  tor- 
pid ftate  of  the  flomach  is  ready  to  produce  fome  dyf- 
peptic  fymptoms,  fuch  vegetable  food  ought,  in  mo- 
derate cafes  of  melancholia,  to  be  ufed  with  fome 
Caution. 

Though  exercife,  as  a  tonic  power,  is  not  proper 
either  in  hypochondriafis  or  melancholia ;  yet,  with 
refpecl:  to  its  effcds  upon  the  mind,  it  may  be  extreme- 
ly ufeful  in  both,  and  in  melancholia  is  to  be  employ- 
ed in  the  fame  manner  that  I  have  advifed  above  in  the 
cafe  of  hypochondriafis. 

MDXCVIII. 

Having  now  delivered  my  doctrine  with  refpecl  to 
the  forms  of  infanity,  I  mould  in  the  next  place  pro- 
ceed to  coniider  the  other  genera  of  Amentia  and 

VOL.  II.  O  o  Oneir 


PRACTICE 

Qneirodynia,  which  in  the  Nofology  I  have  arranged 
under  the  order  of  Vefaniae  :  but  as  I  cannot  pretend 
to  throw  much  light  upon  thefe  fubjects,  and  as  they 
are  feldom  the  objects  of  practice,  I  think  it  allowable 
for  me  to  pafs  them  over  at  prefent ;  and  the  particu- 
lar circumftances  of  this  work  in  fome  meafure  require 
that  I  (hould  do  fo. 


PART.      111. 
OF    CACHEXIES. 

MDXCIX. 

UNDER  this  title  I  propofe  to  eftablim  a  clafs  of 
difeafes,  which  coniift  in  a  depraved  (late  of  the 
whole,  or  of  a  considerable  part,    of  the  habit  of  the 
body,  without  any  primary  pyrexia  or  neurofis  com- 
bined with  that  flate. 

MDC. 

The  term  Cachexy  has  been  employed  by  Linnaeus 
and  Vogei,  as  it  had  been  formerly  by  other  authors, 
for  the  name  of  a  particular  difeale  ;  but  the  difeafe 
to  which  thefe  authors  have  affixed  it,  comes  more 
properly  under  another  appellation  ;  and  the  term  of 
Cachexy  is  more  properly  employed  by  Sauvages  and 
Sagar  for  the  name  of  a  ciafs.  In  this  I  have  follow- 
ed the  laft- mentioned  nofologifls,  though  I  find  it  dif- 
ficult to  give  fuch  a  character  of  the  clafs  as  will  clear- 
ly  apply  to  all  thefpecies  I  have  comprehended  under 
it.  This  difficulty  would  be  ilill  greater,  if,  in  the 
clafs  I  have  eilablifhed  under  the  title  of  Cachexies^  I 
were  to  comprehend  all  the  difeafes  that  thofe  other 
nofologiils  have  done ;  but  I  am  willing  to  be  thought 

deficient 


OF     PHYSIC.  291 

deficient  rather  than  very  incorrect.  Thofe  difficul- 
ties, however,  which  itill  remain  in  methodical  nofo- 
logy,,  miift  not  a  (Feel:  us  much  in  a  treutife  of  practice. 
If  I  can  here  properly  diftjngtrifh  and  defcribe  the  fe- 
veral  fpecies  that  truly  and  moft  commonly  exift,  I 
lhall  be  the  lefs  concerned  about  the  accuracy  of  my 
general  claffification  ;  though  at  the  fame  time  this, 
1  think,  is  always  to  be  attempted  ;  and  I  (hall  purfue 
ix  a-s  well  as  I  can. 


BOOK         I. 

OF     EMACIATIONS. 

MDCI. 

EMACIATION,  or  a  coniiderable  diminution  of 
the  bulk  or  plumpnefs  of  the  whole  body,  is  for 
the  molt  part  only  a  fymptom  of  difeafe5  and  very  fel- 
dom  to  be  confidered  as  a  primary  and  idiopathic  af- 
fection. Upon  this  account,  according  to  my  gene- 
ral plan,  fuch  a  fymptom  might  perhaps  have  been 
omitted  in  the  Methodical  Nofology:  but  both  the 
uncertainty  of  concluding  it  to  be  always  fymptorna- 
tic,  and  the  confiflency  of  fyflem,  made  me  introduce 
into  the  Nofology,  as  others  had  done,  an  order  under 
the  title  of  Marcores  ;  and  this  renders  it  requifite 
now  to  takefome  notice  of  fuch  difeafes. 

MDCI  I. 

Upon  this  occalion,  therefore,  i  hope  it  may  be 
ufeful  to  inveftigate  the  feverai  cauf-s  of  emaciation 
in  all  the  different  cafes  of  difeafe  in  which  it  appears. 
And  this  I  attempt,  as  the  furefl  means  of  determining 
how  far  it  is  primary,  or  a  fymptomatic  affection  on- 

O  o  2  »         \y ; 


PRACTICE 

ly  ;  and  even  in  the  latter  view,  the  investigation  may 
be  attended  with  fome  advantage. 
MDCIH. 

The  caufes  of  emaciation  may,  I  apprehend,  be  refer- 
red to  two  general  heads ;  that  is,  either  to  a  general 
deficiency  or  fluid  in  the  veflels  of  the  body,  or  to  the 
particular  deficiency  of  the  oil  in  the  cellular  tex- 
ture of  it*.  Thefe  caufes  are  frequently  combined 
together;  but  it  will  be  proper,  in  the  firil  place,  to 
ccnfider  them  feparately. 

MDC1V. 

As  a  great  part  of  the  body  of  animals  is  made  up 
of  veflels  filled  with  fluids,  the  bulk  of  the  whole  mud 
depend  very  much  on  the  fi7,e  of  thefe   veffels,   and 
the  quantity   of  fluids    prefent  in  them  :  and  it  will 
therefore  be.  fufliciently  obvious,  that  a  deficiency  of 
the  fluids  in  thefe  veflels  muft,  according  to  its  degree, 
occafion  a  proportionate  diminution  of   the   bulk   of 
the  whole    body.      This,  however,  will  appear  full 
more  clearly,  from  conlidering  that  in  the  living  and 
found  body  the  veflels  every  where  feein  to  be  preter- 
naturally  diftended  by  the  quantity  of  fluids  prefent  in 
them  ;  but  being  at  the  fame  time   elaftic,  and  con-- 
ftantly  endeavouring  to  contract  themfelves,  they  mud 
on    the  withdrawing    of   the  didending  force,  or,  in 
other  words,    upon  a  diminution    of  the  quantity  of 
fluids,  be  in  proportion  contracted  and  dirninifhed  in, 
their   fize:   And  it   may  be  further  obferved,  that  as 
each  part  of  the  vafcular  fydern  communicates  with 
every  other  part  of  it ;  fo  every  degree  of  diminution 
of  the  quantity  of  fluid,  in  any  one  part,  mud  in  pro- 
portion diminifh  the  bulk  of  the  vafcular  fydem,  and 
confequently  of  the  whole  body§. 

MDCV. 

*   Might  not  a  third  caufe  be  added,  viz.  a  deficiency  of  the  fo- 
lid  parts. 

p   There  may,  however,  be  a  partial  without  general  emaciation^ 


O  F    P  H  Y  S  I  C.  293 

MDCV. 

The  diminution  and  deficiency  of  the  fluids  may  be 
occaiioned  by  different  caufes;  fuch  as,  full,  by  a  due 
quantity  of  aliments  not  being  taken  in  ;  or  by  the  ali- 
ment taken  in  not  being  of  a  fufficiently  nutritious 
quality.  Of  the  want  of  a  due  quantity  of  aliment  not 
being  taken  into  the  body,  there  is  an  inftance  in  the 
atrofbia  laftantium  Sauvagefii,  fpecies  3.  and  many 
other  examples  have  occurred  of  emaciation  from 
\vant  of  food,  occaiioned  by  poverty,  and  other  acci- 
dental caufes. 

With  refpe£t  to  the  quality  of  food,  I  apprehend 
it  arifes  from  the  want  of  nutritious  matter  in  the  food 
employed,  that  perfons  living  very  entirely  on  vegeta* 
bles  are  feldoin  of  a  plump  and  iucculent  habit*. 

MDCVI. 

A  fecond  caufe  of  the  deficiency  of  fluids  may  be, 
the  aliments  taken  in  not  being  conveyed  to  the 
blood-veflels.  This  may  octur  from  a  perfon's  being 
affected  with  a  frequent  vomiting  ;  which,  rejecting 
the  food  foon  afcerjc  had  been  taken  in,  mull  prevent 
the  necefiary  fupply  of  fluids  to  the  blood- veffels§. 

Another 

as  is  the  cafe  in  a  pained  lirnb  ;  but  the  partial  diminution  of  bulk, 
in  the  difeafed  limb,  is  not  owing  to  a  lefiened  quantity  of  die  ge- 
neial  mafs  of  the  circulating  fluids,  but  to  the  languid  circulation 
in  that  part,  the  arteries  not  propelling  the  blood  through  it  with 
fiifficicnt  vigour. 

*  As  ihe  author  fays  at  the  conclufion  of  his  chapter,  «'  After 
*'  having  confu'eved  the  various  caiifcs  of  emaciations,  I  faould  per- 
"  haps  treat  of  their  cure  :  but  it  will  readily  appear,  that  the 
*'  greater  part  of  the  cafes  above-mentioned  are  purely  fymptomatic, 
*'  and  confequently  th?t  the  cure  of  them  mu!l  be  that  of  the  pri- 
"  mary  difeaies  upon  which  tht:y  depend.  Of  thofe  cafes  that  can 
"  any  wife  be  confidered  as  idiopathic,  it  will  appear  that  they 
"  are  to  be  cured,  entirely  by  removing  the  lemote  caufes;"  It 
may  not  be  improper  to  treat  of  the  cure  as  we  proceed. 

The  fpecies  of  emaciation  may  be  obvioudy  cured  by  a  rich  and 
nutritious  diet. 

?   This  fpecu'3  may  be  cured  by  preventing  tlic  \omi-/ng  by  an- 


PRACTICE 

Another  caufe,  frequently  interrupting  the  conveyance 
of  the  alimentary  matter  into  the  blood-veffels,  is  an 
obllrueiion  of  the  conglobate  lymphatic  glands  of  the 
niefentery,  through  which  the  chyle  mull  neceflarily 
pafs  to  the  thoracic  duel:.  Many  inftances  of  emacia- 
tion, feemingly  depending  upon  this  caufe,  have  been 
obferved  by  phyficians,  in  perfons  of  all  ages,  but  efpe- 
cially  in  the  young.  It  has  been  remarked,  that  fuch 
cafes  have  moil  frequently  occurred  in  fcrophulous 
perfons,  in  whom  the  mefenteric  glands  are  commonly 
affected  with  tumour  or  obftru&ion,  and  in^  whom, 
generally  at  the  fame  time,  fcrophula  appears  exter- 
nally. Hence  the  Tabes  fcrophulofa  Synop.  Nofolog.  vol. 
ii.  p.  266. :  And  under  thtfe  I  have  put  as  fynonimes 
Tabes  glandularis,  fp.  10. ;  Tabes  mefenterica,  fp.  9. ; 
Scrophuia  mefenterua^  fp.  4.  ;  Atrophia  infant  Hi  s>  fp. 
13.;  Atrophia  rachitica,  fp.  8  ;  Tabes  rachialgica,  fp, 
16.  At  the  fame  time,  I  have  frequently  found  the 
cafe  occurring  in  perfons*  who  did  not  {how  any  exter- 
nal appearance  of  fcrophula,  but  in  whom  the  mefen- 
teric obftrudtion  was  afterwards  difcovered  by  difTec- 
tion.  Such  alfo  I  fuppofe  to  have  been  the  cafe  in 
the  difeaie  frequently  mentioned  by  authors  under  the 
title  of  the  Atrophia  infantum.  This  has  received  its 
name  from  the  time  of  life  at  which  it  generally  ap- 
pears;  but  I  have  met  with  inftances  of  it  at  fourteen 
years  of  age  afcertained  by  diiTeclion.  In  feveral  fuch 
cafes  which  I  have  feen,  the  patients  were  without 
fcrophulous  appearances  at  the  time,  or  at  any  period 
of  their  lives  before*. 

In 

tifpafmodics,    efpecially  opium,  and  by   the  ufe  of  gentle   laxatives 
occafionally.      A    nutritious  diet  will  alfo   be  necelFaiy  in  thefe  ca- 

r 

ies. 

.*  Thefe  cafes  are  generally  incurable  ;  if,  however,  there  be  no 
fufpicicm  of  fcrophula  we  may  attempt  a  cure,  by  endeavouring  to 
remove  the  obdruCtion,  either  by  invigorating  the  habit,  or  by  a6i- 
Open  and  pure  air,  with  exercifc  fuited  to  the 


OF    PHYSIC.  295 

In  the  cafe  of  phthifical  perfons,  I  fhall  hereafter 
mention  another  caufe  of  their  emaciation  ;  but  it  is 
probable  that  an  obftrucuion  of  the  mefenteric  glands, 
which  fo  frequently  happens  in  fuch  perfons,  concurs 
very  powerfully  in  producing  the  emaciation  that 
takes  place. 

Although  a  fcrophulous  taint  may  be  the  moft  fre- 
quent caufe  of  mefenteric  obftructions,  it  is  fufficiently 
probable  that  other  kinds  of  acrimony  may  produce 
the  fame,  and  the  emaciation  that  follows. 

It  may  perhaps  befuppofed,  that  the  interruption  of 
the  chyle's  pafling  into  the  blood-veffels  may  be  forne- 
times  owing  to  a  fault  of  the  abforbents  on  the  inter- 
nal furface  of  the  interlines.  This,  however,  cannot 
be  readily  afcertained  :  but  the  interruption  of  the 
chyle's  paffing  into  the  blood-veffels  may  certainly  be 
owing  to  a  rupture  of  the  thoracic  duel ;  which,  when 
it  does  not  prove  foon  fatal,  by  occafioning  a  hydro- 
thorax,  mult  in  a  fhort  time  produce  a  general  ema- 
ciation*. 

MDCVII. 

A  third  caufe  of  the  deficiency  of  the  fluids  may  be 
a  fault  in  the  organs  of  digeftion,  as  not  duly  convert- 
ing the  aliment  into  a  chyle  fit  to  form  in  the  blood- 
veiTels  a  proper  nutritious  matter.  It  is  not,  however, 
eafy  to  aicertain  the  cafes  of  emaciation  which  are  to 
be  attributed  to  this  caufe  ;  but  I  apprehend  that  the 
emaciation  which  attends  long  fiibfifting  cafes  of  dyf- 
pepfia,  or  of  hypochondriacs,  is  to  be  explained  chief- 
ly in  this  way.  It  is  this  which  I  have  placed  in  the 
Nofology  under  the  title  of  the  Atrophla  debilium  ; 
and  of  which  the  Atropbia  Nervofa,  Sauv.  fp.  i.  is  a 

proper 

flrcngth  of  the  patient,  the  ufe  of  chalybeate  waters,  have  admirable 
effe&s  in  thefc  cafes. 

Peruvian  bark  fo  often  ufed  as  a  tonic,  is  improper  in  all   cafes 
of  obftru£ted  glands,  as  are  alfo  ailringents  and  ftyptics. 
r   This  is  an  abfolutely  incurable  cafe. 


296  PRACTICE 

proper  inftance,  and  therefore  put  there  as  a  fynoniniej 
But  the  other  titles  of  Atrophia  Lateralis,  Sauv.  fp, 
15.  and  Atrophia  fenilis,  Sauv.  fp  1 1.  are  not  fo  pro- 
perly put  there,  as  they  muft  be  explained  in  a  differ- 
ent maimed 

MDCVIII. 

A  fourth  caufe  of  a  deficiency  of  the  fluids  in  the 
body,  may  be  exceffive  evacuations  made  from  it  by 
different  outlets  ;  and  Sauvagcs  has  properly  enume- 
rated the  following  fpecies,  which  we  have  put  as  fy- 
nonimes  under  the  title*of  Atrophia  inanitorum  ;  as, 
Tablet  Nutricum,  fp.  4.  Atrophia  nutricum,  fp.  5.  Atro- 
phia a  leucorrhcea^  fp.  4.  Atrophia  ab  alvifluxu,  fp, 
6/  Atrophia  a  ptyalifmo,  fp.  7.  and  laflly,  the  Tabes  a 
fanguiflnxu  ;  which,  it  is  to  be  obferved,  may  arife  not 
only  from  fpontaneous  hemorrhagies  or  accidental 
wounds,  but  alfo  from  blood-letting  in  too  large  a 
quantity,  and  too  frequently  repeated. 

Upon  this  fubjeft  it  feems  proper  to  obferve,  that 
a  meagre  habit  of  body  frequently  depends  upon  a 
full  perfpiration  being  conflantly  kept  up,  though  at 
the  fame  time  a  large  quantity  of  nutritious  aliment 
is  regularly  taken  in§.. 

MDCIX. 

Befides  this  deficiency  of  fluids  from  evacuations  by 
which  they  are  carried  entirely  out  of  the  body,  there 
may  be  a  deficiency  of  fluid  and  emaciation  in  a  con- 
fulerable  part  of  the  body,  by  the  fluids  being  drawn 
into  one  part,  or  collected  into  one  cavity ;  and  of 

this 

*  This  fpccies  of  emacration  may  be  fuccefsfully  cured  by  the 
means  of  thofe  remedies  mentionedjin  the  notes  on  the  articles  1204, 

1206,1210,  1212,  I2I3>  1215,  I2l6,  I22U 

§  In  thefe  cafes  aftringeuts  are  the  principal  remedies  on  which 
we  muft  depend  ;  and  thole  altringents  mult  be  chofen  which  are  a- 
daptedto  fupprefs  the  peculiar  evacuation  that  occdfions  the  difeafc. 


OF      PHYSIC.  297 

this  we  have  an  inftance  in   the  ^abcs  a  hydrope** 
Sauv.  fp.  5. 

MDCX. 

In  the  Methodical  Noiblogy,  among  the  other  fy* 
nonimes  of  the  Atrophia  inanitorum^  I  have  fet  down 
the  Tabes  dorfatts  •;  but  whether  properly  or  not,  I  at: 
prefent  very  much  doubt.  In  the  evacuation  confi- 
dered  as  the  caufe  of  this  tabes,  as  the  quantity  eva- 
cuated is  never  fo  great  as  to  account  for  a  general  de- 
ficiency of  fluids  in  the  body,  we  muft  feek  for  ano- 
ther explanation  of  it.  And  whether  the  effects  of 
the  evacuation  may  be  accounted  for,  either  from  the 
quality  of  the  fluid  evacuated,  or  from  the  iingularly 
enervating  pleaiure  attending  the  evacuation,  or  from 
the  evacuation's  taking  off  the  tenfion  of  parts,  theten- 
fion  of  which  has  a  (ingular  power  in  fupporting  the 
tenfion  and  vigour  of  the  whole  body,  1  cannot  poli- 
tively  determine  ;  but  I  apprehend  that  upon  one  or 
other  of  thefe  fuppofitions  the  emaciation  attending 
the  tabes  dorfalis  muft  be  accounted  for  ;  and  there- 
fore, that  it  is  to  be  conlidered  as  an  inftance  of  the 
Atrophla  debillum^  rather  than  of  the  Atrophia  inani* 


MDCXI. 

A  fifth  caufe  of  a  deficiency  of  fluids  and  of  emaci* 
ations  in  the  whole  or  in  a  particular  part  of  the  body, 
may  be  the  concretion  of  the  finall  veflels,  either  not 
admitting  of  fluids,  or  of  the  fame  proportion  as  be- 
fore ;  and  this  feems  to  me  to  be  the  cale  in  the  Atro- 
phla  fenilis,  Sauv.  fp.  2.  Or  it  may  be  a  palfy  of  the 
larger  trunks  of  the  arteries  rendering  them  unfit  to 
propel  blood  into  the  fmaller  veffels  ;  as  is  frequently 

VOL.  11.  P  p  the 

*  The  emaciation  from  this  caufe  is  merely  fymptomatic,  and 
can  only  be  cured  by  curing  the  primaryfdiieafe, 

§  If  a  particular  abominable  practice  be  the  caufV,  it  muft  be  a- 
bandoned  before  the  cure  can  be  attempted, 


I*  R  A  G  T  I  C  E 

the  cafe  of  paralytic  limbs,  in  which  the  arteries  air 
affecledas  well  as  tfec  mufcles.     The  Atrophia  later  a^ 
//.r,  Sauv.  fp.  15.  ieems  to  be  of  this  nature*. 
MDCXIL 

A  fecond  general  head  of  the  caufes  of  emaciation  I 
have  mentioned  in  MDCII.  to  be  a  deficiency  of  oil. 
The  extent  and  quantity  of  the  cellular  texture  in 
every  part  of  the  body,  and  therefore  how  confidera- 
ble  patt  it  makes  in  the  bulk  of  the  whole,  is  now  well 
known.  But  this  fubftance,  in  different  circumftan- 
cesj  is  more  or  Ids  filled  with  an  oily  matter  ;  and 
therefore  the  bulk  of  it,  and  in  a  great  meafure  that  of 
the  whole  body,  mud  be  greater  or  lefs  according  as 
this  fub  Trance  is  more  or  lefs  filled  in  that  manner. 
The  deficiency  of  the  fluids,  for  a  reafon  to  be  imme- 
diately explained,  is  generally  accompanied  with  a 
deficiency  of  oil :  but  phylicia-ns  have  commonly  at- 
tended more  to  the  latter  cauie  of  emaciation  than  to 
the  other,  that  being  ufually  the  molt  evident ;  and  I 
fhall  now  endeavour  to  affign  the  fe venal  caufes  of 
the  deficiency  of  oil  as  it  occurs  upon  different  occa- 
fions, 

MDCXIIL 

The  bufmefs  of  fecretion  in  the  human  body  is  in 
general'little  undei'ftood,  and  in  no  inftance  lefs  fo 
than  that  of  the  fecretion  of  oil  from  blood  which 
does  not  appear  previoufly  to  have  contained  it.  It 
is  poflible,  therefore,  that  our  theory  of  the  deficiency 
of  oil  may  be  in  feveral  refpects  imperfect ;  but  there 
are  certain  fads  that  may  in  the  mean  time  apply  t® 
the  prefent  purpofe. 

MDCXIV. 

Firft,  it.  is  probable,  that  a  deficiency  of  oil  may  be 
owing  to  a  ilate  of  the  blood  in  animal  bodies  lefs  fit- 
ted 


only 


This  is  one  of  the  incurable  fpccies  of  emaciation,  and  it 
be  relieved  by  a  very  nutritious  and  invigorating  diet, 


O  F    P  H  Y  S  I  C.  199 

ted  to  afford  a  fecretion  of  oil,  raid  confequcntly  to 
fupply  the  wade  of  it  that  is .  conftantly  made.  This 
flate  of  the  blood  mufl  cfpecially  depend  upon  the 
ftate  of  the  aliments  taken  in,  as  containing  lefs  of  oil 
or  oily  matter.  From  many  observations  made,  both 
\vith  refpeft  to  the  human  body  and  to  that  of  other 
animals,  it  appears  pretty  clearly,  that  tht>  aliments 
taken  in  by  men  and  domeftic  animals,  according  as 
they  contain  more  of  oil,  are  in  general  more  nu 
ous,  and  in  particular  are  better  fitted  to  fill  the  cellu- 
lar texture  of  their  bodies  with  oil.  !  might  illuflrate 
this,  by  a  minute  and  particular  confideratidn  ot  the 
difference  of  alimentary  matters  employed  ;  but  it  will 
be  enough  to  give  two  inftances.  The  one  ;s,  that 
the  herbaceous  part  of  vegetables,  does  not  fatten  -i- 
nimals,  fo  much  as  the  feeds  of  vegetables,  which  rna- 
nifeftly  contain  in  any  given  weight  a  greater  propor- 
tion of  oil ;  and  a  fecond  inilaace  is,  that  in  general 
vegetable  aliments  do  not  fatten  men  fo  much  as  ani- 
rnal  food,  which  generally  contains  a  larger  propor- 
tion of  oil. 

It  will  be  obvious,  that  upon  the  fame  principles  a 
want  of  food,  or  a  lefs  nutritious  food,  may  not 
only  occafion  a  general  deficiency  of  fluids  (MDCIV.) 
but  mufi  alfq.  afford  lefs  oil,  to  be  poured  into  the  cel- 
lular texture.  In  fuch  cafes,  therefore,  the,  emacia- 
tion produced,  is  to  be  attributed  to  both  thefe  general 
caufes*. 

MDCXV. 

A  fecond  cafe  of  the  deficiency  of  oil  may  be  ex- 
plained in  this  manner.  It  is  pretty  manifefl,  thac 
the  oil  of  the  blood  is  facreted  and  deposited  in  the 
cellular  texture  in  greater  or  leffcr  quantity,  according 
as  the  circulation  of  the  blood  is  faller  or  flower  ;  and 

P  p  2  therefore 

*  The  cure  of  this  fpccies  of  emaciation  will  bs  be  ft  cfFv^cd  by 
9  rich  die3*  of  animal  food. 


3co  PRACTICE 

therefore  that  exercife,  which  h aliens  the  circula- 
tion of  the  blood,  is  a  frequent  caufe  of  emaciation. 
Exercife  produces  this  effect  in  two  ways,  ift,  By  in- 
crealing  the  perfpiration,  and  thereby  carrying  off  a 
greater  quantity  of  the  nutritious  matter,  it  leaves  lefs 
of  it  to  be  depofited  in  the  cellular  texture ;  thereby 
not  only  preventing  an  accumulation  of  fluids,  but,  as 
I  have  faid  above,  caufmg  a  general  deficiency  of  thefe, 
which  mud  alfo  caufe  a  deficiency  of  oil  in  the  cellu- 
lar texture,  adly,  It  is  well  known,  that  the  oil  de- 
pofited in  the  cellular  texture  is  upon  many  occafions, 
and  for  various  purpofes  of  the  ceconomy,  again  ab- 
f orbed,  and  mixed  or  diffufed  in  the  mafs  of  blood,  to 
be  from  thence  perhaps  carried  entirely  out  of  the  bo- 
dy by  the  feveral  excretions.  Now,  among  other  pur-* 
pofes  of  the  accumulation  and  re-abforption  of  oil, 
this  feems  to  be  one,  that  the  oil  is  requifite  to  the  pro^ 
per  action  of  the  moving  fibres  in  every  part  of  the 
body  ;  and  therefore  that  nature  has  provided  for  an 
abfcrption  of  oil  to  be  made  according  as  the  action 
of  the  moving  fibres  may  demand  it.  It  will  thus  be 
obvious,  that  the  exercife  of  the  mufctilar  and  moving 
fibres  every  where,  mud  occafion  an  abforption  ,of 
oil ;  and  confequcntJy  that  fuch  exercife  nor  only  pre« 
vents  the  fecretion  of  oil,  as  has  been  already  faid, 
but  may  alfo  caufe  a  deficiency  of  it  by  occafion  ing 
an  abforption  of  what  had  been  depofited  ;  and  in 
this  way,  perhaps  efpecially,  does  it  produce  emacia- 
tion*. 

MDCXVI. 

A.  third  cafe  of  the  deficiency  of  oil  may  occur 
from  the  following  caufe.  It  is  probable,  that  one 
purpofe  of  the  accumulation  of  oil  in  the  cellular  tex- 
ture of  animals  is,  that  it  may,  upon  occafion,  be  again 

abforbed 

*  Abftinence  from  too  fevtre  exercife  is  the  only  cure  for  this 
fpecies  of  the  difeafe. 


O  F    P  H  Y  S  I  C.  301 

abforbed  from  thence,  and  carried  into  the  mafs  of 
blood,  for  the  purpofe  of  enveloping  and  correcting 
any  unufual  acrimony  arifing  and  exifting  in  the  (late 
of  the  fluids.  Thus,  in  mod  inftnnces  in  which  we 
can  difcern  an  acrid  flare  of  the  fluids,  as  in  fcurvy, 
cancer,  fyphilis,  poifons,  and  feveral  other  difeafes, 
we  find  at  the  fame  time  a  deficiency  of  oil  and  an 
emaciation  take  place ;  which,  in  my  appreheniion, 
rnuft  be  attributed  to  the  abforption  of  oil,  which  the 
prcfence  of  acrimony  m  the  body  excites. 

It  is  not  unlikely  that  certain  poifons  introduced  in- 
to the  body,  may  fubfift  there;  and.  giving  occafion 
to  an  abforption  of  oil,  may  lay  a  foundation  for  the 
Tabes  a  veneno*,  Sauv.  fp.  17. 

MDCXVII. 

A  fourth  caufe  of  emaciation,  and  which  I  would 
attribute  to  fudden  and  confiderable  abforption  of  oil 
from  the  cellular  texture,  is  that  of  fever,  which  fo 
generally  produces  emaciation.  This  may  perhaps 
be  in  part  attributed  to  the  increafcd  perfpiration, 
and  therefore  to  the  general  deficiency  of  fluids  that 
may  be  fuppofe.d  to  take  place:  but  whatever  ihare 
that  may  have  in  producing  the  effecl,  we  can,  from 
the  evident  Shrinking  and  diminution  of  the  cellular 
fubflance,  wherever  it  falls  under  our  observation, 
certainly  conclude,  that  there  has  been  a  very  confi- 
derable abforption  of  the  oil  which  had  been  before 
depofited  in  that  fubfcance.  This  explanation  is  ren- 
dered the  more  probable  from  this,  that  I  fuppofe  the 

absorption 

*  As  this  kind  of  emaciation  proceeds  from  various  eaufes,  the 
pra&itioner,  mult,  (after  haying  afcercained  the  true  caufe)  endea- 
vour to  remove  it:  and  this  mull  be  left  entirely  to  his  own  fagacity. 
It  may  however  be  proper  to  obfervc,  that  feveral  of  thefe  emacia- 
tions proceed  from  incurable  difeafes  ;  as  from  Cancer,  Scrophula, 
•See-  and  confequently  admit  of  no  cure  :  And  thofc  emaciations 
Which  proceed  from  fcurvy,  fypljilis,  or  thofe  difeafes  which  we  can 
£iire,  arcQnly  to  be  cured  by  curing  the  primary  dtfeafc. 


302  PRACTICE 

abforpticxn  mentioned  is  necefiarily  made  for  the  pur- 
pofe  of  enveloping  or  corre&ing  an  acrimony,  which 
iiianifcftly  does  in  many,  and  may  be  fufpecled  to 
arife  in  all  cafes  of  fever.*  The  moil  remarkable  in- 
itance  of  emaciation  occurring  in  fevers,  is  that  which 
appears  in  the  cafe  of  he&ic  fevers.  Here  the  emaci- 
ation may  be  attributed  to  profufe  fweatings  that  com- 
monly attend  the  difeafc:  but  there  is  much  reaibn 
to  believe,  that  an  acrimony  is  preient  in  the  blood  ; 
which,  even  in  the  beginning  of  thedifeafe,  prevents 
the  fecretion  and  accumulation  of  oil  ;  and  in  the 
more  advanced  Rates  of  it,  muft  occafion.  a  more  con- 
ftderable  abforption  of  it ;  which,  from  the  Shrinking 
of  the  cellular  fubftance,  feems  to  go  farther  than  in 
almoit  any  other  inftance*. 

Upon  the  fubjecl  of  emaciations  from  a  deficiency 
of  fluids,  it  may  be  obierved,  that  every  increafed 
evacuation  excites  an  abforprion  from  other  parts, 
<!iid  particularly  from  the  cellular  texture;  and  it  is 
therefore  probable,  that  a  deficiency  of  fluids,  from 
increafed  evacuations,  produces  an  emaciation,  not 
only  by  the  waile  of  the  fluids  in  the  vafcuiar  fytiem, 
but  alfo  by  occafioning  a  conliderable  abforption  from 
the  cellular  texture. 

MDCXVIII. 

I  have  thus  endeavoured  to  explain  the  feveral  cafes 
and  caufes  of  emaciation  ;  but  1  could  not  profecute 
the  consideration  of  thefe  here  in  the  order  they  are 
fet  down  in  the  Methodical  Nofology.  Jn  that  work 
I  was  engaged  chiefly  in  arranging  the  fpecies  of  Sau- 
vagcs  ;  but  it  is  my  opinion  now,  that  the  arrange- 
ment there  given  is  erroneous,  in  both  combining  and 
feparating  fpecies  improperly  :  and  it  feems  to  me 

more 

*  This  emaciation  is  purely  fymptomatic,  and  confequently  can- 
not be  cured  hut  by  removing  the  primary  difeafe,  and  a  fubf'.quent 
very  nutritious  diet,  confiiling  chiefly  of  anitr.aj  food. 


,0  F    PHYSIC,  303 

more  proper  here  to  take  notice  of  difeafes,  and  pun 
them  together,  according  to  the  affinity  of  their  na- 
ture, rather  than  by  that  of  their  external  appearances. 
I  doubt,  if  even  the  diftinclion  of  the  Tabes  and  Atro- 
phia,  attempted  in  the  Noiblogy,  will  properly  apply  ; 
as  1  think  there  are  certain  difeafes  of  the  fame  nature, 
which  fometimcs  appear  with,  and  fonietimes  with- 
out, fever. 

MDCXIX. 

After  having  confidered  the  various  oafes  of  ema- 
ciations, I  ihould  perhaps  treat  of  their  cure  :  but  it 
will  readily  appear,  that  the  greater  part  of  the  cafes 
above-mentioned  are  purely  fymptomatic,  and  confc- 
quently  that  the  cure  of  them  mull  be  that  of  the  pri- 
mary difeafes  upon  which  they  depend.  Of  thole  ca- 
fes that  can  any  wile  be  coniidered  as  idiopathic,  it 
will  appear  that  they  are  to  be  cured,  entirely  by  re- 
moving the  remote  caufes ;  the  means  of  accomplifti- 
ing  which  muft  be  fufficiently  obvious. 


BOOK        It. 

O    F 

INTUMESCENTI  .&> 

O    R 

GENERAL     SWELLINGS. 

MDLXX. 

THE  fwellings   to  be  treated  of  in  this  place  arc 
thofe  which  extend  over  the  whole  or  a  great 
part  of  the  body  ;  or  fuch  at  lead,  as,  though  of  ihiaii 

extent; 


304  PRACTICE 

extent,  are  however  of  the  fame  nature  with  triofe  that 
are  more  generally  extenckd. 

The  fvvtrl  lings  comprehended  under  this  artificial 
order,  are  hardly  to  be  diflinguifhed  from  one  another 
other  wife  than  by  the  matter  they  contain  or  conflft 
of:  and  in  this  view  I  have  divided  the  order  into  four 
feclicns,  as  the  fwelling  happens  to  contain,  i//,  Oil  ; 
2d,  Air  ;  yl,  A  watery  fluid ;  or  4^,  As  the  increafed 
bulk  depends  upon  the  enlargement  of  the  whole  fub- 
Ibince  of  certain  parts,  and  particularly  of  one  or  more 
of  the  abdominal  vifcera. 


CHAP.      I. 

OF    ADIPOSE    SWELLINGS. 

MBCXXL 

E  only  difeafe  to  be  mentioned  in  this  chapter, 
J[  I  have,  with  other  Nofologiils,  named  Polyfar- 
cia  ;  and  in  Englifh  it  may  be  named  Corpulency,  or, 
more  fir  icily  Obeiity  ;  as  it  is  placed  here  upon  the 
common  fuppbfition  of  its  depending  chiefly  upon  the 
increafe  of  oil  in  the  cellular  texture  of  the  body. 
This  corpulency,  or  obefity,  is  in  very  different  de- 
grees in  very  different  perfons,  and  is  often  confider- 
able  without  being  coniidercd  as  a  difeafe.  There  is? 
however,  a  cemiii  degree  of  it,  which  will  be  gene- 
rally allowed  to  be  a  difeafe  ;  as,  for  example,,  when 
it  rrnders  per  funs,  fro  in  a  difficult  refpiratiqn,  uneafy 
in  themfelves,  and,  from  the  inability  of  exercife,  un- 
lit for  discharging  the  duties  of  life  to  others  :  and 
for  that  reafon  1  have  given  fuch  a  difeafe  a  place  here. 
Many  phyiicians  have  coniiclered  it  as  an  object  of 

practice, 


OF      PHYSIC.  303 

pradice,  and  as  giving,  even  in  no  very  high  degree,* 
a  diipoficion  to  many  difeafes  ;  I  am  of  opinion  that  it 
mould  be  an  object  of  practice  more  frequently  than  it: 
has  beert,  and  therefore  that  it  merits  our  confidera- 
tion  here. 

MDCXXII. 

It  may  perhaps  be  alledged,  that  I  have  not  beeri 
fufficiently  correct,  in  putting  the  difeafe  of  corpulen- 
cy as  an  intumefcentia  pinguedinofa,  aiid  therefore 
implying  its  being  an  increafe  of  the  bulk  of  the  bo- 
dy from  an  accumulation  of  oil  in  the  cellular  texture 
only.  I  am  aware  of  this  objection  :  and  as  I  have  al- 
ready faid,  that  emaciation  (MDCII.)  depends  either 
upon  a  general  deficiency  of  fluids  in  the  vafcular  fyi- 
tern,  or  upon  a  deficiency  of  oil  in  the  cellular  tex- 
ture ;  io  1  mould  perhaps  have  obferved  farther,  that 
the  corpulency,  or  general  fulnefs  of  the  body,  may 
depend  upon  the  fulnefs  of  the  vafcular  fyftem  as  well 
as.  upon  that  of  the  cellular  texture.  This  is  true ; 
and  for  the  fame  reafons  I  ought,  perhaps,  after  Lin- 
naeus  and  Sagar,  to  have  fet  down  plethora  as  a  parti- 
cular difeafe,  and  as  an  inftance  of  morbid  intume- 
fcence.  I  have,  however,  avoided  this,  as  Sauvages 
and  Vogel  have  done ;  becaufc  I  apprehend  that  ple^ 
thora  is  to  be  confidered  as  a  ftate  of  temperament 
only,  which  may  indeecf  difpofe  to  difeafe ;  but  not  as 
a  difeafe  in  itfelf,  unlefs,  in  the  language  of  the  Statu 
Hans,  it  be  a  plethora  commota,  when  it  produces  a 
difeafe  accompanied  with  particular  fyrnptoms,  which 
give  occiifion  to  its  being  diftinguifhed  by  a  different 
appellation.  Further.,  it  appears  to  me,  that  the 
fymptoms  which  Linnaeus,  arid  more  particularly 
thofc  which  Sagar  employs  in  the  character  of  pletho* 
ra,  never  do  occur  but  when  the  intumefcentia  pin- 
guedinofa  has  a  great  mare  in  producing  them.  It  is, 
however,  very  neceflary  to  obferve  here,  that  plethora 
and  obeiity  are  generally  combined  together;  an$  that 

VOL.  II.  Q^q  iii 


3c6  PRACTICE 

f 

infome  cafe.?  of  corpulency  it  may  be  difficult  to  dc* 
termine  which  of  the  caufes  has  greateft  fhare  in  pro- 
ducing it.  It  is  indeed  very  poffible  that  a  plethora 
may  occur  without  great  obeiity;  but  I  apprehend 
that  obefity  never  happens  to  a  confiderable  degree 
without  producing  a  plethora  ad  fpatium  in  a  great 
part  of  the  fyftem  of  the  aorta,  and  therefore  a  pletho- 
ra ad  molcm  in  the  lungs,  and  in  the  vefTels'of  the 
brain. 

MDCXXIII. 

In  attempting  the  cure  of  polyfarcia,  I  am  of  opi- 
nion that  the  conjunction  of  plethora  and  obefity,  in 
the  manner  juft  now  mentioned,  fhould  be  conllantly 
attended  to  ;  and  when  the  morbid  effects  of  the  ple- 
thoric habit  are  threatened,  either  in  the  head  or  lungs, 
that  blood-letting  is  to  be  practifed :  but  at  the  fame 
time  it  is  to  be  obferved,  that  pedbns  of  much  obefi- 
ty do  not  bear  blood-letting  well ;  and  when  the  cir- 
cumilances  I  have  mentioned  do  not  immediately  re- 
quire it,  the  practice  upon  account  of  obeiity  alone, 
is  hardly  ever  to  be  employed.  The  fame  remark  is 
to  be  made  with  refpect  to  any  other  evacuations  that 
may  be  propofed  for  the  cure  of  corpulency  :  for  with- 
out the  other  means  I  am  to  mention,  they  can  give 
but  a  very  imperfe6t  relief;  and,  in  fo  far  as  they  ei- 
ther empty  or  weaken  the  fyftem,  they  may  favour 
the  return  of  plethora,  and  the  increafe  of  obeiity. 

MDCXXIV. 

Polyfarcia,  or  corpulency, -whether  it  depend  upon 
.plethora  or  obeiity,  whenever  it  either  can  be  confi- 
dered  as  a  difeaie,  or  threatens  to  induce  one,  is  to  be 
cured,  or  the  effects  of  it  are  to  be  obviated,  by  diet 
and  exercife.  The  diet  mufi  be  fparing;  or  rather, 
what  is  more  admirable,  it  inuft  be  fuch  as  affords  lit- 
tle nutritious  matter.  It  nuift  therefore  be  chieily,  or 
alraott  only,  of  vegetable  matter,  and  at  the  very  ut- 
(  mi'lk.  Such  a  diet  fhould  be  employed,  and 

generally 


O  F     P  H  Y  S  I  C.  307 

generally  ought  to  precede  exercife  :  for  obefity  does 
not  eaiily  admit  of  bodily  exercife  ;  'which  is,  h 
ver,  the  only  mode  that  can  be  very  effectual.  Such, 
indeed,  in  many  cafes,  may  feem  difficult  to  be  admit- 
ted; but  I  am  of  opinion,  that  even  the  mod  corpu- 
lent may  be  brought  to  bear  it.  by  at  fir  ft  attempting 
it  very  moderately,  and  -increasing  it  by  degrees  very 
flowly,  but  at  the  fame  time  perfntmg  in  fucli  at- 
tempts with  great  conftancy*. 

MDCXXV/ 

As  thefe,  though  the  only  effectual  meafures,  are 
often  difficult  to  be  admitted  or  carried  into  execu- 
tion, fome  other  means  have  been  though:  of  and  em- 
ployed for  reducing  corpulency.  Thefe,  if  1  mi  flake 
not,  have  all  been  certain  methods  of  inducing  a  falinc 
Hate  in  the  mafs  of  blood  ;  for  fuch  I  fuppole  to  be 
the  effects  of  vinegar  and  of  foap,  which  have  been 
propofed.  The  latter,  1  believe,  hardly  pafies  into 
the  blood-veffels,  without  being  revived  and  formed 
into  a  neutral  fait,  with  the  acid  which-  it  meets  with 
in  the  flomach.  How  well  acrid  and  faline  fubftanc- 
es  are  fitted  to  diminish  obefity,  may  appear  from 
what  has  been  faid  above  in  MDCXV.  What  effects 
vinegar,  foap,  or  other  fubftances  employed,  have 
had  in  reducing  corpulency,  there  have  not  proper 
opportunities  of  obferving  occurred  to  me  :  but  I  am 
well  perfuaded,  that  the  inducing  a  faline  and  acrid 
flate  of  the  blood,  may  have  worfe  confequences  than 
the  corpulency  it  was  intended  to  correct  ;  and  that 
no  perfon  Should  hazard  thefe,  while  we  may  have  re- 
courfe  to  the  more  fare  and  certain  means  of  abfti- 
nence  and  exercife. 


CHAP. 

*  Befides  tlie  means  mentioned   by   th.e  author,    evacuations  of 
4ifFe  ent  kinds  ought  to  be  aecafi«na!'y  made>  efpecially  by 
and  f\yeatin£. 


3o3  PRACTICE 

CHAP.        II. 

OF    FLATULENT    SWELLINGS. 

MDCXXVI. 

THE  cellular  texture  of  the  human  body  very  rea- 
dily admits  of  air,  and  allows  the  fame  to  pafs 
from  any  one  to  every  other  part  of  it.  Hence  Em- 
phyfemata  have  often  appeared  from  air  collected  in 
the  cellular  texture  under  the  fkin,  and  in  feveral 
other  parts  of  the  body.  The  flatulent  fwellings  un- 
der thefkin,  have  indeed  mod  commonly  appeared  in 
confequence  of  air  immediately  introduced  from  with- 
out  :  but  in,  fome  inftances  of  flatulent  fwellings,  efpe- 
cially  thofe  of  the  internal  parts  not  communicating 
with  the  alimentary  canal,  fuch  an  introduction  can- 
not be  perceived  or  fuppofed  ;  and  therefore,  in  thefe 
cafes,  fome  other  caufe  of  the  production  and  collcc* 
tion  of  air  muil  be  looked  for,  though  it  is  often  not 
to  be  clearly  afcertained. 

In  every  folid  as  well  as  every  fluid  fubftance  which 
makes  a  part  of  the  human  body,  there  is  a  confidera- 
ble  quantity  of  air  in  a  fixed  flate,  which  maybe  again 
reftored  to  its  elaftic  flate,  and  fcparated  from  thofc 
fubftances,  by  the  power  of  heat,  putrefaction,  and 
perhaps  other  caufes  :  but  which  of  thefe  may  have 
produced  the  feveral  inftances  of  pneumatofis  and  fla- 
tulent fwellings  that  have  been  recorded  by  authors,  I 
cannot  pretend  to  afcertain,  '  Indeed  upon  account 
of  thefe  difficulties,  I  cannot  proceed  with  any  clear- 
nefs  on  the  general  iubjecl  of  pneumatofis ;  and  there- 
fore, with  regard  to  flatulent  fwellings,  I  find  it  ne- 
ceflary  to  confine  myfelf  to  the  coniideration  of  thofe 
of  the  abdominal  region  alone  ;  which  I  ihall  now  treat 
of  under  the  general  name  of  Tympanites.. 

MBCXXVH, 


OF    PHYSIC.  509 

MDCXXVII. 

The  tympanites  is  a  f welling  of  the  abdomen  ;  in 
which  the  teguments  appear  to  be  much  flrctched  by 
fome  diftcnding  power  within,  and  equally  ftretched 
in  every  polture  of  the  body.  The  fwelling  does  not 
readily  yield  to  any  prelTure ;  and  in  fo  far  as  it  does, 
very  quickly  recovers  its  former  ftate  upon  the  preffure 
being  removed.  Being  ilruck,  it  gives  a  found  like  a 
drum,  or  other  firetched  animal  membranes.  No 
fluctuation  within  is  to  be  perceived  ;  and  the  whole 
feels  Jefs  weighty  than  might  be  expected  from  its  bulk- 
The  uneafinefs  of  the  diilenlion  is  commonly  relieved 
by  the  difcharge  of  air  from  the  alimentary  canal, 
either  upwards  or  downwards. 

MDCXXVIII, 

Thefe  are  the  characters  by  which  the  tympanites 
may  be  diftinguiflied  from  afcites  or  phyfconia  ;  and 
many  experiments  fhow,  that  the  tympanites  always 
depends  upon  a  preternatural  collection  of  air,  fome- 
where  within  the  teguments  of  the  abdomen ;  but 
the  feat  of  the  air  is  in  different  cafes  fomewhat  dif- 
ferent ;  and  this  produces  the  different  fpecies  of  the 
difeafe. 

One  fpecies  is,  when  the  air  collected  is  entirely 
confined  within  the  cavity  of  the  alimentary  canal,  and 
chiefly  in  that  of  the  inteftines.  This  fpecies,  there- 
fore, is  named  the  tympanites  inteftinalis^  Sauv.  fp.  i. 
It  is,  of  all  others,  the  moil  common;  and  to  it  efpe- 
cially  belong  the  characters  given  above.  • 

A  fecond  fpecies  is,  when  the  air  collected  is  ngt 
entirely  confined  to  the  cavity  of  the  inteftines,  but  is 
alfo  prefent  between  tfyeir  coats  ;  and  fuch  is  that 
which  is  named  by  Sauvages  Tympanites  enter Qphyfodes., 
Sauv.  fp.  3.  This  has  certainly  been  a  rare  occur- 
rence ;  and  has  probably  occurred  only  in  confe- 
quence  of  the  tympanites  infytinalit^  by  the  air  efcap- 
jng  from  the  cavity  of  the  inteftines  into  the  inter- 

flices 


3iQ  PRACTICE 

flices  of  the  coats.  It  is,  however,  poffible  that  an 
erofion  of  the  internal  coat  of  the  interlines  may  give 
occafion  to  the  air,  fo  coniLmtly  prefent  in  their  cavi- 
ty, to  efcape  into  the  interiticcs  of  their  coats  though 
in  the  whole  their  cavity  there  has  been  no  previous 
accumulation. 

A  third  fpecies  is,  when  the  air  is  collected  in  the 
fac  of  the  peritonaeum,  or  what  is  commonly  called 
the  cavity  of  the  abdomen,  that  is,  the  fpace  between 
the  peritonaeum  and  vifcera  ;  and  then  the  difeafe  is 
named  tympanites  abdominalis-j  Sauv.  fp.  3.  The  ex- 
iftence  of  fuch  a  tympanites,  without  any  tympanites 
inteftinaliSi  has  been  difputed  ;  and  it  certainly  has 
been  a  r<ire  occurrence  ;  but  from  feveral  directions, 
it  is  unqueftionable  that  fuch  a  difeafe  has  fometimes 
truly  occurred. 

A  fourth  fpeeies  of  tympanites  is,  when  the  tympa- 
nites inieftinalis  and  aM^ni nails  are  joined  together, 
or  take  place  at  the  fame  time.  With  refpect  to  this, 
in  is  probable  that  the  tympanites  inteftinalis  is  the  pri- 
mary difeafe  ;  and  the*  other,  only  a  confequence  of 
the  air  efc  iping,  by  an  erofion  or  rupture  of  the  coats 
of  the  inteftines,  from  the  cavity  of  thefe  into  that  of 
the  abdomen.  It  is  indeed  pofTible,  that  in  confe- 
quence of  erofion  or  rupture,  the  air  which  is  fo  cor*- 
ilantiy  prefent  in  the  inteftinal  canal,  may  cfcape 
from  thence  in  fuch  quantity  into-the  cavity  of  the  ab- 
domen, as  to  give  a  tympanites  abdominalis,  whilfi  there 
was  no  previous  confiderable  accumulation  of  air  in 
the  inteftinal  cavity  itfelf ;  but  I  have  not  facts  to  af- 
certain  this  matter  properly. 

A  fifth  fpecies  has  alfo  been  enumerated.  It  is 
when  a  ivmpanites  abdominalis  happens  to  be  joined 
with  the  hydrops  af cites  ;  and  fuch  a  difeafe  therefore 
is  named  by  Sauvages  tympanites  afciticus^  Sauv.  fp.  4- 
In  moft  cafes  of  tympanites,  indeed,  fome  quantity  of 
fcrum  has,  upon  direction,  -been  found  in  the  fac  of 


O  F    P  H  Y  S  I  C.  3ir 

the  peritonaeum ;  but  that  is  not  enough  to  conftitute 
the  fpecies  now  mentioned,  and  when  the  collection 
of  ferum  is  mure  confidfcrable,  it  is  commonly  where, 
both  from  the  caufes  which  have  preceded,  and  likcwifc 
from  the  fymptoms  which  attend.,  the  afcites  may  be 
confidered  as  the  primary  difeafe  ;  and  therefore  that 
this  combination  does  not  exhibit  a  proper  fpecies  of 
the  tympanites. 

MDCXXIX. 

As  this  laft  is  not  a  proper  fpecies,  and  as  fome  of 
the  others  are  not  only  extremely  rare$  but  even  when 
occurring,  are  neither  primary,  nor  to  be  eafily  diftin- 
guifhed,  nor,  as  confidered  in  themfelves,  admitting 
of  any  cure,  I  fliall  here  take  no  further  notice  of 
them  ;  confining  myfeif  in  what  follows,  to  the  con- 
ii deration  of  the  moil  frequent  cafe,  and.  almoft  the 
only  object  of  practice,  the  tympanites  inteftinalis. 
MDCXXX. 

With  refpect  to  this,  I  cannot  perceive  that  it  arifo* 
in  any  peculiar  temperament,  or  depends  upon  any 
predifpofition,  which  can  be  difcerned.  It  occurs  in 
cither  fex,  at  every  age,  and  frequently  in  young  per- 
fons. 

MDCXXXI. 

Various  remote  caufes  of  it  have  been  affigncd  ;  but 
many  of  thefe  have  not  commonly  the  effecl  of  pro- 
ducing this  difeafe  ;  and  although  fome  of  them  have 
been  truly  antecedents  of  it,  I  can  in  few  inftances 
difcover  the  manner  in  which  they  produce  the  difeafe, 
a,nd  therefore  cannot  certainly  afccrtain  them  to  have 
been  caufes  of  it. 

MDCXXXII. 

The  phenomena  of  {his  difeafe  in  its  feveral  ftagcs 
are  the  following. 

The  tumor  of  the  belly  fcmetimes  grows  very 
quickly  to  a  confiderable  degree,  and  feldom  in  the 
flow  manner  the  afcites  common  Incomes  on.  In  uxr.e 

cafes, 


312  PRACTICE 

cafes,  however,  the  tympanites  comes  on  gradually^ 
and  is  introduced  by  an  unufual  flatulency  of  the  fto- 
mach  and  inteftines,  with  frequent  borborygmi,  and 
an  uncommonly  frequent  expullion  of  air  upwards  and 
downwards.  This  ftate  is  alfo  frequently  attended 
with  colic  pains,  efpecially  felt  about  the  navel,  and 
upon  the  fides  towards  the  back  ;  but  generally  as 
the  difeafe  advances,  thefe  pains  becomes  lefs  confi- 
derable.  As  the  difeafe  advances,  there  is  a  pretty 
conftant  defire  to  difcharge  air,  but  it  is  accomplimed 
\vith  difficulty^;  and  when  obtained,  and  although  it 
gives  fome  relief  from  the  fenfe  of  diftenfion,  this  re- 
lief is  commonly  tranlient  and  of  fhort  duration. — 
While  the  difeafe  is  coming  on,  fome  inequality  of  tu- 
mour and  teniion  may  be  perceived  in  different  parts 
of  the  belly;  but  the  dilteniion  foon  becomes  equal 
over  the  whole,  and  exhibits  the  phenomena  mention- 
ed in  the  character.  Upon  the  firft  coming  on  of  the 
difeaie,  as  well  as  during  its  progrefs,  the  belly  is 
bound,  and  the  faeces  difcharged  are  commonly  hard 
and  dry.  The  urine,  at  the  beginning,  is  ufually  ve- 
ry little  changed  in  quantity  or  quality  from  its  natu- 
ral ftate  :  but  as  the  difeafe  continues,  it  is  commonly 
changed  in  both  refpects  ;  and  at  length  fornetimes 
a  ftranguary,  and  even  an  ifchuria,  comes  on.  The 
difeafe  has  feldom  advanced  far,  before  the  appetite  is 
much  impaired,  and  digeilion  ill  performed  ;  and  the 
'  whole  body,  except  the  belly,  becomes  confidently 
emaciated.  Together  with  thefe  fymptoms,  a  thirit 
and  uneafy  fenfe  of  heat  at  length  comes  on,  and  a 
conficierably  frequency  of  pulfe  occurs,  which  conti- 
nues throughout  the  courfe  of  the  difeafe.  When  the 
tumor  of  the  belly  arifes  to  a  conliderable  bulk,  the 
breathing  becomes  very  difficult,  with  a  frequent  dry 
cough.  With  all  thefe  fyrnptoms  the  ftrength  of  the 
patient  declines;  and  the  febrile  fymptoms  daily 
increaiihcr  death  at  leneth  en llues,  fometimes  proba- 

bly 


O  F    P  H  Y  S  I  C.  313 

My  in  coafequence  of  a  gangrene  coming  upon  the 
inteftines. 

MDCXXXIH. 

The  tympanites  is  commonly  of  fome  duration,  and 
to  be  reckoned  a  chronic  difeafe.  Jt  is  very  feidom 
quickly  fatal,  except  where  fach  an  affedion  fudden- 
ly  arifes  in  fevers.  To  this  Sauvages  has  properly 
given  a  different  appellation,  that  of  Meteor  if mus  ;  and 
I  judge  it  may  always  be  conftdered  as  a  fyniptomatic 
affection,  entirely  diilind  from  the  tympanites  we  ate 
now  coniidering. 

MDCXXXIV. 

The  tympanites  is  generally  a  fatal  difeafe,  feidom 
admitting  of  cure;  but  what  may  be  attempted  in  this 
way,  I  iriall  try  to  point  out,  after  I  fhall  have  endea- 
voured to  explain  the  proximate  caufe,  which  alond 
can  lay  the  foundation  of  what  may  be  rationally  at- 
tempted towards  its  cure. 

MDCXXXV. 

To  ascertain  the  proximate  caufe  of  tympanites,  is 
fome  what  difficult.  It  has  been  fuppofed  in  many 
cafes,  to  be  merely  an  uncommon  quantity  of  air  pre- 
fent  in  the  alimentary  canal,  owing  to  the  extrication 
and  detachment  of  a  greater  quantity  of  air  than  ufu- 
al  from  the  alimentary  matters  taken  in.  Our  vegeta- 
ble aliments,  I  believe,  always  undergo  fome  degree  of 
fermentation  ;  and  in  confequence,  a  quantity  of  afir  is 
extricated  and  detached  from  them  in  the  ftomach 
and  inteftines ;  but  it  appears  that  the  mixture  of  the 
animal  fluids  which  our  aliments  meet  with  in  the  ali- 
mentary canal,  prevents  the  fame  quantity  of  air  from 
being  detached  from  them  that  would  have  been  in 
their  fermentation  without  fuch  mixture  ;  and  it  is 
probable  that  the  fame  mixture  contributes  alib  to  the 
reabforption  of  the  air  that  had  been  before  in  fome 
meafure  detached.  The  extrication,  therefore,  of  an 
imufual  quantity  of  air  from  the  aliments,  may,  in 

VOL.  II.  R  r 


3H  PRACTICE 

« 

tain  circumftances,  be  fuch,  perhaps,  as  to  produce'  £ 
tympanites:  fo  that  this  difeaie  may  depend  upon  a 
fault  of  thedigeftive  fluids,  whereby  they  are  unfit  to 
prevent  the  too  copious  extrication  of  air,  and  unfit  al- 
ib  to  occafion  that  reabforption  of  air  which  in  found 
perfons  commonly  happens.  An  unufual  quantity  of 
air  in  the  alimentary  canal,  whether  owing  to  the  na- 
ture of  the  aliments  taken  in,  or  to  the  fault  of  the 
digefkive  fluid,  does  certainly  fometimes  take  place; 
and  may  poffibiy  have,  and  in  fome  meafure  certainly 
has,  a  mare  in  producing  certain  flatulent  diforders  of 
the  alimentary  canal ;  but  cannot  be  fuppofed  to  pro- 
duce the  tympanites,  which  often  occurs  when  no 
previous  diibrder  had  appeared  in  the  fyftem.  Evea 
in  thofe  cafes  of  tympanites  which  are  attended  at 
their  'beginning  with  flatulent  diforders  in  the  whole  of 
the  alimentary  canal,  as  we  know  that  a  firm  tone  of 
the  interlines  both  moderates  the  extrication  of  ak 
and  contributes  to  its  leabforption  or  ready  expulfion, 
fo  the  flatulent  fymptcms  which  happen  to  appear  at 
the  coining  en  of  a  tympanites,  are,  in  my  opinion,  to 
be  referred  to  a  lofs  of  tone  in  the  mufcular  fibres  of 
the  inteiiines,  rather  than  to  any  fault  in  the  digeftivc 
fluids. 

MDCXXXVL 

Thefe,  and  other  confiderations,  lead  me  to  con- 
clude, that  the  chief  part  of  the  proximate  caufe  of 
tympanites,  is  a  lofs  of  tone  in  the  mufcular  fibres  of 
the  interlines.  But  further,  as  air  of  any  kind  accu- 
mulated in  the  cavity  of  the  inteiiines  mould,  even  by 
its  own  elailicity,  find  its  way  either  upwards  or  down- 
wards, and  fliould  alfo,  by  the  affifhatice  of  infpira- 
tioir,  be  entirely  thrown  out  of  the  body ;  fo,  when 
neither  the  reabforption  nor  the  expulfion  takes  place, 
and  the  air  is  accumulated  fo  as  to  produce  tympan- 
ites, it  is  probable  that  the  pafTage  of  the  air  along 
the  courfe  of  the  inteftines  is  in  fome  places  of  thefe 

inter- 


OF     PHYSIC.  315 

interrupted.  This  interrupt  ion,  However,  caii  hardly 
be  fuppofed  to  proceed  from  any  other  caufe  than 
fpafmodic  conditions  in  certain  parts  of  the  canal; 
-and  I  conclude,  therefore,  th.it  fuck  c  mitricUons  con* 
cur  as  part  in  the  proximate  cauic  ot  tympanites. — 
Whether  thefe  fpafmodic  conductions  are- to  bp  attri- 
buted to  the  remote  caufe  of  the  difeafc,  or  may  be 
confidered  as  theconfequence  of  f  >me  degree  of  atony 
fird  ariiing,  I  cannot  with  certainty,  and  do  not  find  it 
ncceflary  to  determine. 

MDGXXXVII. 

Having  thus  endeavoured  to  afcertain  the  proxi- 
mate caufe  of  tympanites,  I  proceed  to  ticat  of  its 
cure  ;  which  indeed  has  fcldom  fucceeded,  and  al- 
jnod  never  but  in  a  recent  difeafe.  I  mud,  however, 
endeavour  to  fay  what  may  be  reafonably  attempted; 
what  has  commonly  been  attempted  ;  and  what  at- 
temprs  have  fometimes  fucceeded  in  the  cure  of  this 
difcafe. 

MDCXXXVI1I. 

It  mud  be  a  fird  indication  to  evacuate  the. air  ac- 
cumulated in  the  interlines  :  and  for  this  purpofe  it  is 
neceflary  that  thofe  conftric"lions,  which  had  especially 
occafioned  its  accumulation,  and  continue  to  inter- 
rupt its.  paifage  along  the  courie  of  the  inteftines 
fhould  be. removed.  As  tlic-fe,  Jiowcver,  «an  hardly 
be  removed  but  by  exciting  the  perid«-:itic  motion  in 
the  adjoining  portions  of  the  inreflines,  purgatives 
have  beer,  commonly  employed  ;.  but  it  is  at  the  fame 
time  agreed,  that  the  more  gentle  laxatives  only  ^ught 
to  be  employed,  as  the  more  drafuc,  in  the  overftretch- 
ed  and  tenfe  flate  of  the  intedines,  arc  in  danger  of 
bringing  on  inflammation. 

It  is   for    this  reafon,  alf>,   that  glyucrs  have  been . 
frequently  employed  ;  and  they  are  the  more  necefla- 
ry, as  the  faeces  collected  are  generally  found  to  be  in 
a  hard  and  dry  date.     Not   only  upon  account  of  this 

R  r  2  -  date 


3i6  PRACTICE 

Hate  of  the  faeces,  but,  farther,  when  glyfters  produce 
a  confiderable  evacuation  of  air,  and  thus  fhow  that 
they  have  fome  effect  in  relaxing  the  fpafms  of  the 
inteftines,  they  ought  to  be  repeated  very  frequently. 
MDCXXXIX. 

In  order  to  take  off  the  conftridions  of  the  intef- 
tines, and  with  fome  view  alfo  to  the  carminative  ef- 
fecls  of  the  medicines,  various  antifpafmodics  have 
been  propofed,  and  commonly  employed  ;  but  their 
effects  are  feldom  confiderable,  and  it  is  alledged  that 
their  heating  and  inflammatory  powers  have  fome- 
times  been  hurrful.  It  it,  however,  always  proper  to, 
join  fome  of  the  milder  kinds  with  both  the  purgatives 
and  glyflers  that  are  employed*  ;  and  it  has  been  ve* 
ry  properly  advifed  to  give  always  the  chief  of  antif- 
pafmodics, that  is,  an  opiate,  after  the  operation  of 
purgatives  is  finifhed, 

MDCXL. 

In  confideration  of  the  overftretched  tenfe,  andcjry 
ftate  of  the  inteftines,  and  efpccially  of  the  fpafmodic 
conftrictions  that  prevail,  fomentations  and  warm 
bathing  have  been  propofed  as  a  remedy  ;  and  are 
faid  to  have  been  employed  with  advantage  :  but 
it  has  been  remarked,  that  very  warm  baths  have  no£ 
been  found  fo  ufeful  as  tepid  baths  long  continued, 
MDCXLI. 

Upon  the  fuppofition  that  this  difeafe  depends  efpe- 
-cially  upon  an  atony  of  the  alimentary  canal,  tonic  re- 
medies 

*  The  antifpafmodics  that  are  to  be  joined  with  purgatives  ought 
to  be  efTential  oi'K  efpec'ally  the  effential  oils  of  umbelliferous 
plains,  as  oil  of  anifeed,  oil  ofcarui,  £c.  and  their  dofe  ought  to  be 
moderate.  In  many  cafes  they  may  be  ufed  in  repeated  fmall  dofes 
by  themfelves  on  a  piece  of  fugar.  The  dofe  of  the  ol.  anifi  ought  , 
wot  to  exceed  ten  pr  twelve  drops,  nor  of  the  ol.  carui  nve  drops ; 
larger  dofes  are  too  heating.  It  may  be  proper  alfo  to  obferve,  that 
the  effential  oils  of  the  verticellated  plants,  .as  mint,  marjoram, 
thyme,  &c.  are  much  too  heating,  and  much  more  fo  thofe  oi  the 
aromaticS)  as  cloves,  cinnamon,  &c. 


O  F     P  H  Y  S  I  G. 

medics  feem  to  be  properly  indicated.  Accordingly 
chiilybeatcs,  and  various  bitters,  have  been  employed  ; 
and,  if  any  atonic*,  the  Peruvian  bark  might  probably 
be  ufeful. 

MDCXLII, 

But  as  no  tonic  remedy  is  more  powerful  than  cold 
applied  to  the  furface  of  the  body,  and  cold  drink 
thrown  into  the  ftomach  ;  fo  fuch  a  remedy  has  been 
thought  of  in  this  difeafe.  Cold  drink  has  been  con- 
ftantly  prefcribed,  and  cold  bathing  has  been  employed 
with  advantage;  and  there  have  been  federal  in- 
flarsces  of  the  difeafe  being  fuddenly  and  entirely  cur- 
ed by  the  repeated  application  of  fnow  to  the  lower 
belly: 

MDCXLIIL 

It  is  hardly  neceiTary  to  remark,  that,  in  the  diet  of 
tympanitSc  perfons,  all  forts  of  food  ready  to  become 
flatulent  in  the  ftomach  are  to  be  avoided  ;  and  it  is 
probable,  that  the  foffil  acids  and  neutral  (kits,  as  an- 
tizymics,  may  be  ufefulj. 

MDCXLIV. 

In  obflinate  and  defperate  cafes  of  tympanites,  the 
operation  of  the  paracentefis  has  been  propofed  :  but 
it  is  a  very  doubtful  remedy,  and  there  is  hardly  anr 
teftimony  of  its  having  been  practifed  with  fuccefs. 
It  mud  be  obvious,  that  this  operation  is  a  remedy 
fiiited  efpecially,  and  almoft  only,  to  the  tympanites 
abdominalis  ;  the  exiftence  of  which,  feparately  from 
the  inteflinaUs,  is  very  doubtful,  at  leaft  not  ealily  af- 
certained.  Even  if  its  exiflence  could  be  afcertained, 
yet  ic  is  not  very  likely  to  be  cured  by  this  remedy ; 

and 

*  The  author  here  furely  tr»eant  to  fay  tonic  ;  and  atonic  feems 
to  be  a  typographical  error  ;  but  it  was  fo  printed  in  the  lad  edition 
publilhed  before  his  death. 

§  The  foffil  acids  arc  undoubtedly  very  powerful  in  refilling  fer- 
mentation ;  and  if  the  air  in  the  fnteltines  1*5  produced  by  fermenta- 
tion, they  are  con  fervently  highly  ufefuL 


3i3  PRACTICE 

and  how  far  the  operation  might  be  fafe  in  the  tympan- 
ites inteftinalis,  is  not  yet  determined  by  any  propey 
experience. 


CHAP.         III. 
OF  WATERY  SWELLINGS,  OR  DROPSIES. 


MDCXLV. 

A  PRETERNATURAL  colkaion  of  ferous  or 
watery  fluids,  is  often  formed  in  different  parts 
of  the  human  body  ;  and  although  the  difeafe  thence 
nrifmg  he  diflinguiiried  according  to  the  different 
parts  which  it  occupies,  yet  the  whole  of  fuch  collec- 
tions come  under  the  general  appellation  of  Dropiits. 
At  the  fame  time,  although  the  particular  inflances 
of  fuch  colledion  are  to  be  diftinguiihed  from  each 
other  according  to  the  parts  they  occupy,  as  well  as  by 
other  circumilances  attending  them;  yet  all  of  them 
feem  to  depend  upon  fome  general  caufes,  very  much 
in  common  to  the  whole.  Before  proceeding, 
therefore,  to  confider  the  feveral  fpecies,  it  may  be 
proper  to  endeavour  to  affign  the  general  caufes  of 
dropfy. 

MDCXLVL 

In  perfons  in  health,  a  ferous  or  watery  fluid  ftem? 
to  be  conftantly  poured  out,  or  exhaled  in  vapour,  in- 
to every  cavity  and  interface  of  the  human  body  ca- 
pable of  receiving  it ;  and  the  fame  fluid,  without  re- 
maining long  or  being  accumulated  in  thefe  fpaces, 
feems  conftamly  to  be  foon  again  abfoibed  frors 
thence  by  veflels  adapted  to  the  purpofc.  From  this 


OF    PHYSIC.  319 

View  or  the  animal  ceconomy,  it  will  be  obvious,  that 
if  the  quantity  poured  out  into  any  fpace,  happens 
to  be  greater  than  the  abforbents  can  at  the  fame 
time  take  up,  an  unufual  accumulation  of  ferous  fluid 
will  be  made  in  fuch  parts  ;  or  though  the  quantity 
poured  out  be  not  more  than  ufual,  yer  if  the  abforp- 
tion  be  any  wife  interrupted  or  diminished,  from  this 
caufe  alfo  an  unufual  collection  of  fluids  may  be  occa- 
iioned. 

Thus,  in  general,  dropfy  may  be  imputed  to  an 
increafed  efYuiicn,  or  to  a  diminifhed  abforption  ;  and 
I  therefore  proceed  to  inquire  into  the  feverai  caufes 
of  thefe. 

MDCXLVII. 

An  increafed  effuiion  may  happen,  either  from  a 
preternatural  increafe  of  the  ordinary  exhalation,  or 
from  the  rupture  of  veifels  carrying,  or  of  facs  con- 
taining, ferous  or  watery  fluids. 

MDCXLVIII. 

The  ordinary  exhalation  may  be  increafed  by  vari- 
ous caufes,  and  particularly  by  an  interruption  given 
to  the  free  return  of  the  venous  blood  from  the  ex- 
treme veflels  of  the  body  to  the  right  ventricle  of  the 
heart.  This  interruption  feems  to  operate  by  refitting 
the  free  pailage  of  the  blood  from  the  arteries  into  the 
veins,  thereby  increafing  the  force  of  the  arterial  flu- 
ids in  the  exhalants,  and  confequently  the  quantity  of 
fluid  which  they  pour  out. 

MDCXLIX. 

The  interruption  of  the  free  return  of  the  venous 
blood  from  the  extreme  veiTels,  may  be  owing  to  cer- 
tain circumftances  affecting  the  courfe  of  the  venous 
blood  ;  very  frequently,  to  certain  conditions  in  the 
righc  ventricle  of  the  heart  itfelf,  preventing  it  from 
receiving  the  ufual  quantity  of  blood  from  the  vena 
eava  ;  or  to  obftruclions  in  the  veffels  of  the  lungs  pre- 
venting the  entire  evacuation  of  the  right  ventricle, 

and 


32o  PRACTICE 

and  thereby  hindering  its  receiving  the  ufaal  quan- 
tity of  blood  from  the  cava.  Thus,  a  polypus  in  the 
right  ventricle  of  the  heart*  and  the  oflitication  of  its 
valves,  as  well  as  all  confiderable  and  permanent  cb- 
ilruclions  of  the  lungs,  have  been  found  to  be  caufes 
of  dropfy. 

MDCL. 

It  may  ferve  as  an  illuftration  of  the  operation  of 
thefe  general  caufes,  to  remark,  that  the  return  of  the 
venous  blood  is  in  fome  meafure  refitted  when  the 
pofture  of  the  body  is  fuch  as  gives  occafion  to  the 
gravity  of  the  blood  to  oppofe  the  motion  of  it  in  the 
veins,  which  takes  effect  when  the  force  of  the  circu- 
lation is  weak  ;  and  from  whence  it  is  that  an  upright 
pofture  of  the  body  produces  or  increafes  ferous  fwell- 
ings  in  the  lower  extremities. 

MDCLL 

Not  only  thofe  caufes  interrupting  the  motion  of 
the  venous  blood  more  generally,  but,  farther,  the  in- 
terruption of  it  in  particular  veins,  may  likewife  have 
the  effect  of  increafing  exhalation,  and  producing 
dropfy.  The  moil  remarkable  mitance  of  this  is, 
•when  confiderable  obfh'uclioris  of  the  liver  prevent 
the  blood  from  flowing  freely  into  ic  from  the.  vena 
portaium  and  its  numerous  branches ;  and  hence  thefe 
obftruclions  are  a  frequent  caufe  of  dropfy. 
MDCLIL 

Scirrhofitics  of  the  fpleen  and  other  vifcera,  as  well 
as  the  fcirrhofity  of  the  liver,  have  been  confuiered 
as  caufes  of  dropfy  ;  but  the  manner'  in  which  they 
can  produce  the  difeafe,  I  do  not  perceive,  except  it 
may  be  where  they  happen  to  be  near  fome  confider- 
able vein,  by  the  compreffion  of  which  they  may  oc- 
cafion fome  degree  of  afcites  ;  or,  by  completing  the 
vena  cava,  may  produce  an  anafarca  of  the  lower  ex- 
tremities. It  is  indeed  true,  that  fcirrhofities  of  the 
fpleen  and  other  vifcera,  have  been  frequently  difco- 

v -red 


O  F     P  H  Y  S  I  C.  321 

vered  iii  the  bodies  of  hydropic  perfons  :  but  I  be- 
lieve they  have  .been  ieldom  found  unlefs  when  fcir- 
rhofities  of  the  liver  were  alfo  prefent ;  and  I  am  in- 
clined to  think,  that  the  former  have  been  the  effects 
of  the  latter,  rather  than  the  caufe'of  the  dropfy  ;  or, 
that,  if  fcirrtioriries  of  the  other  vifcera  have  appeared 
in  hydropic  bodies  when  that  of  the  liver  was  not  pre- 
fenr,  they  muft  have  been  the  effects  of  fome  of  thofe 
caufes  of  dropfy  to  be  hereafter  mentioned  ;  and  con- 
fequently  to  be  the  accidental  attendants,  rather  than 
the  caufes,  of  fuch  dropiies. 

MDCLIII. 

Evert  in  fmaller  portions  of  the  venous  fyfleni,  the 
interruption  of  the  morion  of  the  blood  in  particular 
veins  has  had  the  fame  effect.  Thus  a  polypus  form- 
ed in  the  cavity  of  a  vein,  or  tumours  formed  in  its 
coats,  preventing  the  free  pafTageof  the  blood  through 
it,  have  had  the  effect  of  producing  dropfy  in  parts  to- 
wards the  extremity  of  fuch  veins. 
MDCLIV. 

But  the  caufe  mid  frequently  interrupting  the  mo- 
tion of  the  blood  through  the  veins  is,  the  compreffi-? 
ori  of  tumours  exiiting  near  to  them;  fuch  as  aneu- 
rifrns  in  the  arteries,  abfceifes,  and  fcirrhous  or  fteato 
matous  tumours  in  the  adjoining  parts. 

To  this  head  may  be  referred  the  comprefiion  of 
the  defccnding  cava  by  the  bulk  of  the  uterus  in  preg- 
nant women,  and  the  compreffion  of  the  fame  by  the 
bulk  of  water  in  the  afcites ;  both  of  which  comprefli- 
ons  frequently  produce  ferous  fwellings  in  the  lower 
extremities. 

MDCLV. 

It  may  be  fu.p'pofed,  that  a  general  preternatural 
plethora  of  the  venous  fyftem  may  have  the  effect  of 
increafing  exhalation ;  and  that  this  plethora  may 
happen  from,  the  fuppreffion  of  fluxes,  or  evacuations 
of  blood,  which  had  for  forae  time  taken  place  in  the  * 

VOL,  !L  S  s  body, 


322  PRACTICE 

body,  fuch  as  the  menftrual  and  hemorrhoidal  fluxes. 
A  dropfy,  however,  from  fuch  a  caufe,  has  been  at 
leail  a  rare  occurrence;  and  when  it  fecms  to  have 
happened,  I  fhould  fuppofe  it  owing  to  the  fame  caul-, 
es  as  the  fuppreilion  itfelf,  rather  than  to  the  pletho- 
ra produced  by  it. 

iMDCLVL 

»  One  of  the  moft  frequent  caufes  of  an  iricrenfed  ex- 
halation, I  apprehend  to  be  the  laxity  of  the  exhalant 
veiTels.  That  fuch  a  caufe  may  operate,  appears  pro- 
bable from  this,  that  paralytic  limbs,  in  which  fuch  a 
laxity  is  to  be  fufpeded,  are  frequently  affected  with 
ferous,  or,  as  they  are  called,  cedematous  fwellings. 

But  a  much  more  remarkable  and  frequent  exam- 
ple of  its  operation  occurs  in  the  cafe  of  a  general  de- 
bility of  the  fyftem,  which  is  fo  often  attended  with 
dropfy.  That  a  general  debility  does  induce  dropfy, 
appears  fufficiently  from  its  being  fo  commonly  the 
confequence  of  powerfully  debilitating  caufes ;  fuch 
as  fevers,  either  of  the  continued  or  intermittent  kind, 
which  have  laded  long ;  long-continued  and  fome- 
what  excefiive  evacuations  of  any  kinds ;  and  in  mort, 
almofb  all  difeafes  that  have  been  of  long  continu- 
ancej  and  have  at  the  fame  time  induced  the  other 
fymptoms  of  a  general  debility. 

Among  other  caufes  inducing  a  general  debility  of 
tlie  fyftem,  and  thereby  dropfy,  there  is  one  to  be 
mentioned  as  frequently  occuning,  and  that  is,  in- 
temperance in  the  ufe  of  intoxicating  liquors  ;  from 
whence  it  is  that  drunkards  of  all  kinds,  and  efpsci* 
ally  dram-drinkers,  are  fo  afFeded  with  this  difcafe. 
MDCLVII. 

That  a  general  debility  may  produce  a  laxity  of  the 
exhalants,  wifl  be  readily  allowed  :  and  thar  by  this 
cfpecialJy  it  occafions  dropfy,  I  judge  from  thence, 
that  while  mr ft  of  the  caufes  already  mentioned  arc 
fulled  to  produce  dro'pfles  of  particular  parts  only,  the  \ 

flare  ! 


0  F    E  H  Y  S  I  C.  323 

(late  of  general  debility  gives  rife  to  increafed  exhala- 
tion into  every  cavity  and  interface  of  the  body,  and 
therefore  brings  on  a  general  difeafe.  Thus,  we  have 
feen  effufions  of  a  ferous  fluid  made,  at  the  fame  time, 
Into  the  cavity  of  the  cranium,  into  that  of  the  thorax 
and  of  the  abdomen,  and  likewife  into  the  cellular  tex- 
ture almoft  over  the  whole  of  the  body.  In  fuch  caf- 
€S,  the  operation  of  a  general  caufe  difcovered  itfelf, 
by  thefe  feveral  dropfies  increafmg  in.  one  part  as  they 
diminifhed  in  another,  and  this  alternately  in  the  dif- 
ferent parts.  This  combination,  therefore,  of  the  dif- 
ferent fpecies  of  dropfy,  or  rather,  as.it  may  be  term- 
ed, this  univerfal  dropfy,  rauft,  I  think,  be  referred  to 
a  general  caufe  ;  and  in  mod  inftances,  hardly  any  o- 
ther  can  be  thought  of,  but  a  general  laxity  of  the  ex- 
halants.  It  is  this,  therefore,  that  I  call  the  hydropic 
diatbefis  ;  which  frequently  operates  by  itfelf;  and 
frequently,  in  fome  rneafure,  concurring  with  other 
caufes,  is  efpecially  that  which  gives  them  their  full 


This  flate  of  the  fyftem,  in  its  firft  appearance, 
feems  to  be  what  has  been  confidered  as  a  particular 
difeafe  under  the  name  of  Cachexy  ;  but  in  every  in- 
ftance  of  it  that  has  occurred  to  me,  I  have  always 
confidered,  and  have  always  found,  it  to  be  the  be- 
ginning of  general  dropfy. 

MDCLVIIL 

The  feveral  caufes  of  dropfy  already  mentioned  nriy 
produce  the  difeafe,  although  there  be  no  preternatu- 
ral abundance  of  ferous  or  watery  fluid  in  thebloofl- 
vefTels  ;  but  it  is  now  to  be  remarked,  that  a  preterna- 
tural abundance  of  that  kind  may  often  give  occafioii 
to  the  difeafe,  and  more  efpecially  when  fuch  abun- 
dance concurs  with  the  caufes  above  enumerated. 

One  caufe  of  fuch  preternatural  abundance  may  be 
an  unufuai  quantity  of  water  taken  into.  the  body. 
Thus  an  unufuai  quantity  of  water  takeriin  by  drink- 

S  s  2  ing, 


PRACTICE 

ing,  has  fome times  occailoned  a  dropfy.  Large  quan- 
tities of  water,  it  is -true,  are  upon  many  occafions 
taken  in  ;  and  being  as  readily  thrown  out  again  by 
ftool,  urine,  or  perfpiration,  have  not  produced  any 
difeafe.  But  it  is  alib  certain,  that  upon  fome  occa- 
lions,  an  unufual  quantity  of  watery  liquors  taken  in 
has  run  off  by  the  feveral  internal  exhalants,  and  pro- 
duced a  dropfy.  This  feems  to  have  happened,  ei- 
ther from  the  excretories  not  being  fitted  to  throw  out 
the  fluid  fo  fa  ft  as  it  had  been  taken  in,  or  from  the 
excretories  having  been  obftru&ed  by  accidentally 
concurring  caufes-  Accordingly  it  is  laid,  that  the 
fudden  taking  in  of  a  large  quantity  of  very  cold  wa- 
ter, has  produced  dropfy,  probably  from  the  cold  pro- 
ducing a  conftri&ion  of  the  excretories. 

The  proportion  of  watery  fluid  in  the  blood  may  be 
increafed,  not  only  by  the  taking  in  a  large  quantity 
of  water  by  drinking,  as  now  mentioned,  but  it  is 
poffible  that  it  may  be  increafed  alfo  by  water  ta.ken 
in  from  the  atmofphere  by  the  ikin  in  an  abforbiag  or 
imbibing  Hate.  It  is  well  known  that  the  ikin  may 
be,  at  lead,  occasionally  in  fuch  a  itate ;  and  it  is  pro- 
bable, that  it  many  cales  of  beginning  dropfy,  when, 
the  circulation  of  the  blood  on  the  fur  face  of  the  bo- 
dy is  very  languid,  that  the  ikin  may  be  changed 
from  a  perfpiring  to  an  imbibing  ilate ;  and  thus,  at 
"leaft,  the  difeafe  may  be  very  much  increafed. 

MDCLIX 

A  fecond  caufe  of  a  preternatural  abundance  of  wa- 
fSty  fluids  in  the  blqod-veilels,  may  be,  nn  interrup- 
tion of  the  ordinary  watery  excretions  ;  and  according- 
•ly  it  is  alledged,  that  perfons  much  expofed  to  a  cold 
and  moid  air  are  liable  to  dropfy.  It  is  alfo  faid,  that 
an  interruption,  or  confide  ruble  diminution,  of  the 
urinary  fecretion,  has  produced  the  difeafe  :  and  it  is 
certain,  that  in  the  cafe  of  an  tfcburia  renalis,  the  ie- 
rofity  retained  in  the  b  ,  cilcis  has  been  poured 

puc 


Of      P  H  Y  S  I  C.  325 

out  into  fome  internal  cavities,  and  has  occaFicmed 

diopfy. 

MDCLX. 

A  third  caufe,  of  an  over-proportion  of  ferous  fl'.Usi 
in  the  blood  ready  to  run  off  by  the  exhalants,  has 
been  very  large  evacuations  of  blood,  either  fpontane- 
ous  or  artificial.  Thefe  evacuations,  by  abfiracling  a 
large  proportion  of  red  globules  and  gluten,  which  are 
the  principal  means  of  retaining;  lerum  in  the  red  vef>- 
fels,  allow  the  ferum  to  run  off  more  readily  by  the 
exhalants :  and  hence  dropfies  have  been  frequently 
the  confequence  offuch  evacuations. 

It  is  poflible  alfo,  that  large  and  long-continued  if- 
fues,  by  abstracting  a  large  proportion  of  gluten,  may 
have  the  fame  effecl:. 

An  over-proportion  of  the  ferous  parts  of  the  blood, 
may  not  only  be  owing  to  the  fpoliation  juft  now  men- 
tioned, but  may,  I  apprehend,  be  likewife  owing  to 
a  fault  in  the  digeiling  and  affimiJating  powers  in  the 
itomach  and  otiier  organs ;  whereby  they  do  not  pre- 
pare and  convert  the  aliments  taken  in,  in  fuch  a 
manner  as  to  produce  from  them  the  due  proportion 
of  red  globules  and  gluten  ;  but,  flill  continuing  to 
fupply  the  watery  parts,  occafion  thefe  to  be  in  an  o- 
ver-proportion,  and  confequently  ready  to  run  off  in 
too  large  quantity  by  the  exhalants.  It  is  in  this 
manner  that  we  explain  the  dropfy,  fo  often  attending 
cblorofis  :  which  appears  always  at  firft  by  a  pale  co- 
lour of  the  whole  body,  ihowing  a  manileft  deficien- 
cy of  red  blood  ;  which  in  that  difeafp  can  only  be 
atuibuted  to  an  imperfect  digeftion  and  uffirnilation. 
Whether  a  like  imperfection  takes  place  in  what 
lias  been'cailed  a  Cachexy,  1  dare  not  determine.  This 
difeafe  indeed  has  been  commonly  and  very  evidently 
owing  to  the  general  caufes  of  debility  above  mention- 
ed :  and  it  being  probable  that  the  general  debility 
piay  affefl:  the  organs  of  digeflion  and  ailimilation  ;  fo 

the 


S2(>  PRACTICE 

the  imperfect  ilate  of  thefe  functions,  occafioning  ^ 
deficiency  of  red  globules  and  gluten,  may  often  con- 
cur with  the  laxity  of  the  exhalants  in  producing 
dropfy. 

MDCLXI. 

Thefe  are  the  feveral  caufes  of  increafed  exhalation, 
which  I  have  mention?d  as  the  chief  caufe  of  the  ef- 
fufion  producing  dropfy  ;  but  I  have  likewife  obferv- 
ed  in  MDCXLVII;  that  with  the  fame  effect,  an  effu- 
lion  may  alfo  be  made  by  the  rupture  of  veffels  carry- 
ing watery  fluids. 

'In  this  way,  a  rupture  of  the  thoracic  duct,  has  giv- 
en occalion  to  sin  effufion  of  chyle  and  lymph  into 
the  cavity  of  the  thorax  :  and  a  rupture  of  the  lacte- 
als  has  occafioned  a  like  effufion  into  the  cavity  of  the 
abdomen  j  and  in  either  cafe,  a  dropfy  has  been  pro- 
duced. 

It  is  fufikiently  probable,  that  a  rupture  of  lympha- 
tics, in  confequence  of  drains,  or  the  violent  com- 
preflion  of  neighbouring  mufcles,  has  occafioned  an 
effufion  ;  which,  being  diffufed  in  the  cellular  texture, 
has  produced  dropfy. 

It  belongs  to  this  head  of  caufes,  to  remark,  thr.t 
there  are  many  inftances  of  a  rupture  or  erofion  of  the. 
kidneys,  ureters,  and  bladder  of  urine  ;  whereby  the 
urine  has  been  poured  into  the  cavity  of  the  abdomen, 
and  produced  an  afcites. 

MDCLXII. 

Upon  this  fubject,  of  the  rupture  of  veffels  carrying, 
or  of  veficles  containing,  watery  fluids,  I  muft  obferve, 
that  the  direction  of  dead  bodies  has  often  mown  ve- 
iicles  formed  upon  the  furface  of  many  of  the  inter- 
nal parts  ;  and  it  has  been  fuppofed  that  the  rupture 
offuch  veficles,  commonly  named  Hydatides,  together 
with  their  continuing  to  pour  out  a  watery  fluid,  has 
been  frequently  the  caufe  of  dropfy.  I  cannot  deny 

the 


OF    PHYSIC  327 

the  poffibility  of  fuch  a  caufe,  but  fufpeft  the  matter 
muft  be  explained  in  a  different  manner. 

There  have  been  frequently  found,  in  almofl  every 
different  part  of  animal  bodies,  collections  of  fpherical 
veficles,  containing  a  watery  fluid ;  and  in  many  cafes 
of  fuppofed  dropfy,  particularly  in  thofe  called  the 
preternatural  encyfted  dropfies,  the  fvvelling  has  been 
entirely  owing  to  a  collection  of  fuch  hydatides.  Ma- 
ny conjectures  have  been  formed  with  regard  to  the 
nature  arid  production  of  thefe  veficles  ;  but  the  mat- 
ter at  lad  feems  to  be  afcertained.  Ir  feems  to  be  cer- 
tain, that  each  of  thefe  veiicles  has  within  it,  or  an- 
nexed to  it,  a  living  animal  of  the  worm  kind;  which 
feems  to  have  the  power  of  forming  a  veficle  for  the 
purpofe  of  its  own  ceconomy,  and  of  filling  it  with  a 
watery  fluid  drawn  from  the  neighbouring  parts :  and 
this  animal  has  therefore  been  properly  named  by  late 
naturalifts,  the  Ttsnia  hydatigma.  The  ofigin  and 
ceconomy  of  this  animal,  cr  an  account  cf  the  feverai 
parts  of  the  human  body  which  it  occupies.,  I  cannot 
profecute  further  here  ;  but  it  was  proper  for  me,  in 
delivering  the  caufes  of  dropfy,  to  fay  thus  much  of 
hydatides  :  and  I  mull  conclude  with  obferving,  1  am 
well  perfdaaed,  that  moll  of  the  inltances  of  preterna- 
tural encyfted  dropfies  which  have  appeared  in  many 
different  parts  of  the  human  body,  have  been  truly 
collections  of  fuch  hydatides  5  but  how  the  fvvellings 
occafioned  by  thefe  are  to  be  diftinguifhed  from  other 
fpecies  of  dropfy,  or  how  they  are  to  be  treated  in 
practice,  I  cannot  at  prefent  determine. 
MDCLXIII. 

After  having  mentioned  thefe,  I  return  to  confider 
the  other  general  caufe  of  dropfy,  which  I  have  faid 
in  MDCXLVI.  may  be,  An  interruption  or  diminution 
of  the  abforption  that  fhould  take  up  the  exhaled  flu- 
ids from  the  feverai  cavities  and  interftices  of  the  bo- 

dv: 


PRACTICE 

dy  ;  the  caufes  of  which  interruption,  however,  are 
not  eafily  afcertaincd. 

MDCLXIV. 

It  Teems  probable,  that  abforption  may  be  diminim- 
ed,  and  even  ceafe  altogether,  from  a  lofs  of  tone  ia 
the  abforbent  extremities  of  the  lymphatics.  .  I  can- 
not indeed  doubt  that  a  certain  degree  of  tone  or  act- 
ive power  is  neceflary  in  thefe  abforbent  extremities  ; 
and  it  appears  probable,  that  the  fame  general  debili- 
ty which  produces  that  laxity  of  the  cxhalant  veiTels, 
wherein  I  have  fnppofed  the  hydropic  diatheils  to  con- 
lift,  will  at  the  fame  time  occafion  a  lofe  of  tone  in  the 
abforbents  ;  and  therefore  that  a  laxity  of  the  exha- 
lants  will  generally  be  accompanied  with  a  lofs  of 
tone  in  the  abforber.ts ;  and  that  this  will  have  a  mare 
in  the  production  of  dropfy.  Indeed  it  is  probable 
that  the  diminution  of  abforption  has  a  considerable 
ihare  in  the  matter  :  as  dropiies  are  often  cured  by 
medicines  which  feem  to  operate  by  exciting  the  acti- 
on of  the  abforbents. 

MDCLXV. 

It  has  been  fuppofed,  that  the  abforption  performed 
by  the  extremities  of  lymphatics  may  be  interrupted 
by  an  obftruction  of  thefe  veftels,  or  at  lead  of  the 
conglobate  glands  through  which  thefe  vefiels  pafs. 
This,  however,  is  very  doubtful.  As  the  lymphatics 
have  branches  frequently  communicating  with  one 
another,  it  is  not  probable  that  the  obft  ruction  of  any 
one,  or  even  feveral  of  thefe^  can  have  any  conficlera- 
ble  effect  in  interrupting  the  abforption  of  their  extre- 
mities. 

And  for  the  fame  reafon  it  is  as  little  probable  that 
the  obllruclion  of  conglobate  glands  can  have  fuch  an 
effect  :  at  leaft  it  is  only  an  obftruction  of  the  glands 
of  the  mefentery,  through  which  fo  considerable  a  por- 
tion of  the  lymph  paffes,  that  can  poffibly  have  the  ef- 
lect  of  interrupting  abforpticn.  But  even  this  we 

ihould 


OF    PHYSIC.  329 

not  readily  fuppofe,  there  being  re.ifon  to  he- 
lieve  that  thefe  glar.as,  even  in  a  coniiderably  tume- 
fied Hate,  are  not  entirely  obftrudkd  :  And  according- 
ly I  have  known  fevcral  inftances  of  the  .rnoft  part  of 
the  mefcnteric  glands  being  coniiderably  tumefied, 
without  either  interrupting  the  tranfmifiion  of  fluids 
to  the  blood- veiTels,  or  occasioning  any  dropfy. 

An  hydropic  fwelling,  indeed,  feems  often  to  affect 
the  arm  fYou*  a  tumour  of  the  axillary  glancl :  but  ic 
feems  to  me  doubtful,  whether  the  tumour  of  the  atm. 
may  not  be  owing  to  fome  eompreffioh  of  the  axilla- 
ry vein,  rather  thari  to  an  obitruction  of  the  lympha- 
tics, t 

MDCLXVI. 

A  particular  interruption  of  abforption  may  be  fup- 
poied  to  take  place  in  the  brain.  As  no  lymphatic 
veflel's  have  yet  very  certainly  been  difcovere'd  in  that 
organ,  it  may  be  thought,  that  the  abforption,  which 
certainly  takes  place  there,  is  performed  by  the  extre- 
mities of  veins,  or  by  veffels  that  carry  the  fluid  di- 
rectly into  the  veins  ;  fo  that  any  impediment  to  the 
free  motion  of  the  blood  in  the  veins  or  the  brain, 
may  interrupt  the  abforption  there,  and  occaiion  that 
accumulation  of  ferous  fluid  which  fo  frequently  oc- 
curs from,  a  congeftion  of  blood  in  thefe  veins.  But 
I  give  all  this  as  a  matter  of  conjecture  only. 
MDCLXVII. 

Having  thus  explained  the  general  caufes  of  drop- 
fy, I  ihould  proceed,  in  the  next  place,  to  mention  the 
ieveral  paits  of  the  body  in  which  ferous  collections 
take  place,  and  fo  to  mark  the  diiFerent  fpecies  of 
dropfy  :  but  I  do  not  think  it  neceifary  for  me  to  en- 
ter into  any  minute  detail  upon  this  fubjed.  In  ma- 
ny cafes  thefe  collections  are  not  to  be  afcertained  by 
any  external  fymptoms,  and  therefore  cannot  be  the 
bbjecls  of  practice  ;  and  many  of  them,  though  in 
fome  meafure  difcernible,  do  not  feem  to  be  curable 

VOL.  .II.  T  t  by 


33*  PRACTICE 

by  our  art.  I  the  more  efpecially  avoid  mentioi 
very  particularly  the  fpecies,  becaufe  that  has  already 
been  fufficiently  done  by  Dr.  D.  Monro,  and  other 
writers,  in  every  body's  hands.  I  muft  confine  my- 
felf  here  to  the  confideration  of  thofe  fpecies  which  are 
the  mod  frequently  occurring  and  the.moft  common 
objects  of  our  practice;  which  are,  the  Anaforca, 
Hydrothorax,  and  Afcites  ;  and  each  of  thefe  I  fhall 
treat  in  fo  many  feparate  fectioiis. 


SECT.         I. 

OF       A  N  A  S  A  R  C  A, 

MDCLXVIII. 

THE  Anafarca  is  a  fwelling  upon  the  furface  of  the 
body,  at  firft  commonly  appearing  in  particular  part* 
only,  but  at  length  frequently  appearing  over  the 
whole.  So  far  as  it  extends,  it  is  an  uniform  fwelling 
over  the  whole  member,  at  firft  always  fofc,  and  rea- 
dily receiving  the  preiTure  of  the  finger,  which  forms 
a  hollow  that  remains  for  fome  little  time  after  the 
prefFure  is  removed,  but  at  length  rifes  again  to  its 
former  fulnefs.  This  fwelling  generally  appears,  firft, 
upon  the  lower  extremities  ;  and  there  too  only  in  the 
evening,  difapp  earing  again  in  the  morning.  It  is 
ufually  more  confiderable  as  the  perfon  has  been 
more  in  an  erect  pofture  during  the  day ;  but  there 
are  many  inflances  of  the  exercife  of  walking  prevent- 
ing altogether  its  otherwife  ufual  coming  on.  Al- 
though this  fwelling  appears  at  firft  only  upon  the  feet 
and  about  the  ankles ;  yet  if  the  caufes  producing  it 
continue  to  act?  it  gradually  extends  upwards5  occu- 
pying 


OF    PHYSIC.  331 

pying  the  legs,  thighs,  and  trunk  of  the  body,  and 
fome times  even  the  head.  Commonly  the  (welling  of 
the  lower  extremities  diminimes  during  the  night; 
and  in  the  morning,  the  fwelling  of  the  face  is  moft 
conliderable,  which  again  generally  difappears  aimoft 
entirely  in  the  courfe  of  the  day. 
MDCLXIX. 

The  terms 'of  Anafarca  and  Leucophkgmatia  have 
been  commonly  contidered  as  fynonimous  ;  but  fome 
authors  have   propofed  to  confider  them  as  denoting 
didinct  difeafes.     The   authors   who   are   of  this  laft 
opinion  employ  the  name  of  Anafarca  for -that  difeafe 
which  begins  in  the  lower  extremities,  and  is  from 
thence  gradually  extended  upwards  in  the  manner  I 
have  juft  now  defcribed  ;  while  they  term  Leucophleg- 
inatia-)  that  in  which  the  fame  kind  of  fweliing  appears 
even-  at   firft  very   generally  over  the  whole   body. 
They  feemto  think  alfo,  that  the  two  difcafes  proceed 
from  different  caufes ;   and   that,    while  the  anafarca 
may  arife  from  the  feveral  caufes  in  MDCXLVIU. — M- 
DCLIX.  the  leucophlegmatia  proceeds  efpecially  from 
a  deficiency  of  red  blood,  as  we  have  mentioned  in  M- 
DCLX.    et  feq.     I   cannot,    however,  find  any  proper 
foundation  for  this  diftinclion.     For  although  in  drop- 
lies  proceeding  from  the  caufes  mentioned  m  MDCLX, 
et  feq.  the  difeafe  appears  in  fome  cafes  more  immedi- 
ately affecting  the  whole  body  ;  yet  that  does  not  eftu- 
bliih  a  difference  from  the  cmnmon  cafe  of  anafarca : 
for  the  difeafe,  in  all  its  circum (lances,  comes  at  length 
TO  be  entirely  the  fame  ;  and  in  cafes  occaiioned  by  a 
deficiency  of  red  blood,  I  have  frequently  obferved  it 
to  come  on  exactly  in  the  manner  of  an  anaiarca>  as 
above  defcribed. 

MDCLXX. 

An  anafarca  is  evidently  a  preternatural  called!  m 
of  ferous  fluid  in  the  cellular  texture  immediately  un- 
der the  fkin.  Sometimes  pervading  the  ikin  iciclf,  it 

T  t  2  oozes 


332  PRACTICE 

oozes  out  through  the  pores  of  the  cuticle;  and  feme- 
times,  too  grofs  to  pafs  by  thefe,  it  raifes  the  cuticle  in 
bliftcrs.  Sometimes  the  fkin,  not  allowing,  the  water 
to  pervade  it,  is  compreffed  and  hardened,  and  at  the 
fame  time  Co  much  diftended,or  to  give  anafarcous  tu- 
mours an  unufual  firmnefs.  It  is  in  thcfe  laft  circum- 
ilances  alfo  that  an  erythematic  inflammation  is  ready 
to  come  upon  anafarcous  fwellings. 
MDCLXX1. 

An  anafarca  may  immediately  arife  from  any  of  the 
feveral  caufes  of  droply  which  acl  more  generally  up- 
on the  fyfiem  :  and  even  when  other  fpecies  of  dropfy 
jfrom  particular  circumilances,  appear  firft ;  yet  when- 
ever thefe  proceed  from  any  caufes  more  generally  af- 
fecting the  fyftem,  an  anarfaca  fooner  or  later  comes 
alwavs  to  be  joined  with  them. 

MDGLXXII. 

The  manner  in  which  this  difeafe  commonly •  firft 
appears,  will  be  readily  explained  by  what  I  have  fa  id. 
in  MDCL.  refpecling  the  efFccls  of  the  pofhtre  of  tiie 
body.  Its  gradual  progrefs,  and  its  affecting,  aft  en 
f  ~>me  time,  not  only  the  cellular  texture  under  the  fkin, 
but  probably  alfo  much  of  the  fame  texture  in  the  in- 
ternal parts,  will  be  underitood  partly  from  the  com- 
munication that  is  readily  made  between  the  fcveral 
parts  of  the  cellular  texture;  but  efpecially  from  the 
fame  general  caufes  of  the  difeife  producing  their  ef- 
fects in  every  p;irt  of  the  body.  It  appears  to  me, 
that  the  water  of  anafarcous  fwellings  is  more  readily 
communicated  to  the  cavity  of  the  thorax,  and  to  the 
lungs,  than  to  the  cavity  of  the  abdomen,  or  to  the 
vifcera  contained  in  it, 

MDCLXXIII. 

An  anafarca  is  almoft  always  attended  with  a  fcarci- 

.  ty  of  urine  ;  and  the  urine  voided,  is,  from  its  fcarci- 

ty  always  of  a  high  colour ;  and  from  die  fame  caufe, 

alter  cooling,  readily  lets  fall  a  copious  reddiih  fedi- 


O  1'      ?  H  Y  S  I  C.  333 

ment.  This  fcarciry  of  urine  may  fometinves  be  ow- 
ing to  an  obft  ruction  of  the  kidneys  ;  but  probably  is. 
generally  occaiioned  by  the  watery  parts  of  the  blood 
running  off  into  the  cellular  texture,  and  being 
thereby  prevented  from  pafiing  in  the  ufual  quantity  to 
the  kidneys. 

The  difeafe  is  dfo  generally  attended  with  r_n  unu- 
fual  degree  of  thh'ii  ;  a  circlirriftance  I  would  attribute 
to  a  like  abftracticn  of  fluid  from  the  tongue  and  fauces, 
which  are  extremely  .feniible  tu  every  diminution  of 
the  fluids  in  thefe  parts. 

MDCLXXIV. 

The  cure  of  anafarca  is  to  be  attempted  up  m  tkree 
general  indications. 

1.  The  removing  the  remote  caufes  of"  the  diftafc. 

2.  The   evacuation  of  the  fcrous  fluid  already  col- 
lected in  the  cellular  texture. 

3.  The  reftoring  the  tone  of  the  fyftem,  the  lofs  of 
which  may  be  confidered  in  many  cafes  as  the  proxi- 
mate catife  of  the  diieafe. 

MDCLXXV. 

The  remote  caufes  are  very  often  fuch  ns  had  not 
only  been  applied,  but  had  been  removed*  long 'be- 
fore the  difeafe  came  on.  Although,  therefore,  their 
effects  remain,  the  caufes  themfelves  cannot  be  the 
objects  of  practice  ;  but  if  the  caufes  iliii  continue  to 
be  applied,  fuch  as  intemperance,  indolence,  and  ibm.e 
others,  they  mull  be  removed.  For  the  moil  part, 
tne  remote  ciules  are  ceria'ri  difcafcs  previous  to  the 
cropfy,  which  are  to  be  cured  by  the  remedies  parti- 
cularly adapted  to  them,  and  cannot  be  treated  of 
bere.  The  curing  of  thefe,  indeed,  may  be  often  dif- 
ficult ;  but  it  was  proper  to  lay  down  the  prefent  in- 
dication, in  order  to  ihow,  that  when  thefe  remote 

caufes 

*  Thrfe  arc  l.'rcje  evacuations  of  different  kin^s,  b'.n  efp^ci^ji/ 
bemorrhagies,  which  HHVX  ceafcd  beloic  the  ciropiy  came  on, 


334 


PRACTICE 


caufes  cannot  be  removed,  the  cure  of  the  dropfy 
muft  be  difficult,  or  perhaps  impoffible.  In  many 
cafes,  therefore,  the  following  indications  will  be  to 
little  purpofe  ;  and  particularly,  that  often  the  execu- 
tion of  the  fecond  will  not  only  give  the  patient  a 
great  deal  of  fruitlefs  trouble,  but  commonly  alfo  hur- 
ry on  his  fate. 

MDCLXXVL 

The  fecond  indication  for  evacuating  the  collected 
ferum,  may  be  fomedmes  executed  with  advantage, 
and  often,  at  leaft,  with  temporary  relief.  It  may  be 
performed  in  two  ways.  Firil,  by  drawing  off  the 
water  directly  from  the  dropfical  part,  by  openings 
made  into  it  for  that  purpofe  :  Or,  fecoridly,  by  ex- 
citmg  certain  ferous  excretions ;  in  confequence  of 
which,  an  abforption  maybe  excited  in  the  dropfical 
parts,  and  thereby  the  ferum  abforbed  and  carried  into, 
the  blood- veiTels  may  afterwards  be  directed  to  run 
out,  or  may  fpontaneoufly  pafs  out,  by  one  or  other  of 
the  common  excretions. 

MDCLXXV1I. 

In  an  anafarca,  the  openings  into  the  dropfical  part 
are  commonly  to  be  made  in  fome  part  of  the  lower 
exiremeties ;  and  will  be  mod  properly  made  by  ma- 
ny fmall  punctures  reaching  the  cellular  texture.  For- 
merly, considerable  incifions  were  employed  for  this 
purpofe  :  but  as  any  wound  made  in  dropfical  parts, 
which,  in  order  to  their  healing,  mull  necefTarily  in- 
flame and  fuppurate,  are  liable*  to  become  gangre- 
nous ;  fo  it  is  found  to  be  much  fafer  to  make  the  open-. 
ings  by  fmall  punctures  only,  which  may  heal  up  by 
the  firft  intention.  At  the  fame  time,  even  with  re- 
fpect  to  thefe  punctures,  it  is  proper  to  obferve,  that 
they  mould  be  made  at  fome  diftance  from  one  another, 

and 

*   Peculiarly  liable  in  this  difeafe  on  account  of  the  dimi'nifhcd 
tone  and  confequently  the  diminifbed  Ibrength  of  the  parts. 


OF      PHYSIC.  335 

and    that  care  fhould  be  taken  to  avoid  making  them 
in  the  moft  depending  parts. 

MDCLXXVIIL 

The  water  of  anafarcous  limbs  may  be  fometimes 
drawn  off  by  pea-ifliies,  made  by  cauftic  a  little  below 
the  knees  :  for  as  the  great  fuelling  of  the  lower  ex- 
tremities is  chiefly  occafioned  by  the  ferous  fluid  ex- 
haled into  the  upper  parts  conftantly  falling  down  to 
the  lower;  fo  theiffuesnow  mentioned,  by  evacuating 
the  water  from  thefe  upper  parts,  may  very  much  relieve 
the  whole  of  the  difeafe.  Unlefs,  however,  the  ifiues  be 
put  in  before  the  difeafe  is  far  advanced,  and  before 
the  parts  have  very  much  loll  their  tone,  the  places 
of  the  iffues  are  ready  to  become  affected  with  gan- 


grene. 


Some  practical  writers  have  advifed  the  employ- 
ment of  fetons,  for  the  fame  purpofe  that  I  have 
propofed  iffues ;  but  I  apprehend,  that  fetons  will 
be  more  liable  than  iflues  to  the  accident  juft  now 
mentioned. 

MDCLXXIX. 

For  the  purpofe  of  drawing  out  ferum  from  anafar- 
cous limbs,  blifters  have  been  applied  to  them,  and 
fometimes  with  great  fuccefs;  but  the  bliftered  parts  are 
ready  to  have  a  gangrene  come  upon  them.  Bliftering 
is  therefore  to  be  employed  with  great  caution;  and 
perhaps  only  in  the  circumilances  that  I  have  mention- 
ed above  to  be  fit  for  the  employment  of  iflues. 
MpCLXXX. 

Colewort-leaves  applied  to  the  (kin,  readily  occafiori 
a  watery  exfudation  from  its  furface ;  and  applied  to 
the  feet  and  legs  affected  with  anafarca,  have  fome- 
times  drawn  off  the  water  very  copioufly,  and  with 
great  advantage. 

Analogous,  as  I  judge,  to  this,  oiled  filk-hofe  put 
upon  the  feet  and  legs,  fo  as  to  (hut  out  all  communi- 
cation with  the  external  air,  have  been  found  fome- 
times to  draw  a  quantity  of  water  from  the  pores  of 

the 


330  PRACTICE 

the  {kin,  and  are  fa  id  in  this  way  to  have  relieved  and.* 
farcous  fwel tings;  but  in  feveral  trials  made,  I  have 
never  fc-und  either  the  application  of  thefe  hole,  or 
that  of  the  cule  Wort-leaves,  of  much  fervice. 

MDCLXXXI. 

^Thefetorid  means  propofed  in  MDCLXXVI.  for  draw- 
ing  off  the  water  from  dropiical  places,  may  be  the 
employment  of  emetics,  purgatives,  diuretics,  or  fu- 
dorifics*.  • 

MDCLXXXII. 

As  fpontaneous  vomiting  has  fometimes  excited  an 
abforption  in  hydropic  parts,  and  thereby  drawn  off 
the  waters  lodged  in  them,  it  is  reasonable  to  fuppoie 
that  vomiting  excited  by  art  may  have  the  fame  effect ; 
and  accordingly  it  has  been  often  praclifed  with  ad- 
vanrage.  The  practice,  however,  requires  that  the 
flrong  antimonial  emetics  be  employed,  and  that  they 
be  repeated  frequently  after  fhort  intervals. 
MbCLXXXIII. 

Patients  fubmit  more  readily  to  the  ufe  of  .purga- 
tives, than  to  that  of  emetics ;  and  indeed  they  com- 
monly beas  the  former  more  eaiily  than  the  latter. 
At  the  fame  time,  there  are  no  means  we  can  employ 
to  procure  a  copious  evacuation  of  ferous  fluids  with 
greater  certainty  than  the  operation  of  purgatives,  and 
it  is  upon  thefe  accounts  that  purging  is  the  evacuation 
which  has  been  moil:  frequently,  and  perhaps  with 
moil  fuccefs,  employed  in  dropfy.  It  has  been  gene- 
rally found  neceflary  to  employ,  purgatives  of  the  more 
drailic  kind  ;  which  are  commonly  known,  and  need 
riot  be  enumerated  here*.  I  believe,  indeed,  that 

the 

*.  How  does  this  lad  agree  with  the  firft  fen  fence  of  this  aiiticle? 

§  The  Draitic  purgatives  are  Jalap,  Colocynth,  Gamboge, 
Scammony,  &c.  Their  Drailic  quality  however  depends  very  much 
on  the  dole  in  which  they  are  given,  fmali  dofes  being  gently  laxa- 
tive, while  large  ones  are  very  violent  in  their  operation.  The/ 
ought  Jeldom  to  be  given  alone,  but  in  conjunction  with  fume  aro-- 
ic,  which  grcuily  increafcs  tht-ir  action,  and  at  the  fame  lime 


O  F    P  H  Y  S  I  G.  33? 

the  more  draftic  purgatives  arc  the  moft  effectual  for  ex- 
citing abforption,  as  their  flimulus  is  mod  readily  com* 
municated  to  the  other  parts  of  the  fyftem ;  but  of  late 
an  opinion  has  prevailed,  that  feme  milder  purgatives 
may  be  employed  with  advantage.  This  opinion  has 
prevailed  particularly  with  regard  to  rhe  cryilals  vul^ 
garly  called  the  Cream  of  Tartar,  which  in  large  dof- 
es,  frequently  repeated,  have  fometimes  anfwered  the 
purpofe  of  exciting  large  evacuations  both  by  ftool  and 
urine,  and  has  thereby  cured  dropfies.  This  medi- 
cine, however,  has  frequently  failed,  both  in  its  opera- 
VOL.  II.  Uu  tion 

prevents  the  uneafinefs  of  griping,  with  which  their  operation  is  fre- 
quently attended  :  moft  of  thefe  drafh'cs  being  refinous  fubftances, 
they  are  difficultly  foluble  in  the  alimentary  canal,  or  if  reduced  to 
a  powder  they  are  liable  to  concrete  ;  in  either  cafe  their  adlion  is 
impeded.  To  remedy  thete  inconveniencies,  it  is  ufuul  to  add  to* 
them  fame  fait,  which  both  divides  the  refin  and  prevents  it's  con- 
cretion ;  and  confequently  inct cafes  it's  aclion.  For  thefe  reafons, 
we  find  in  the  (hops  many  formula?,  in  which  the  draftic  icfins  are 
mixed  with  either  faits  or  aromatics,  or  both  :  As,  the  Pulvis  Aloe- 
ticus,  Pulvis  e  Scammonio  compofitus,  Pulvis  e  Scammonio  cum  A- 
Ice,  Pulvis  e  fenna  compoiitus,  and  Ele£luarium  e  Scammonio  of  the 
Londen  Pharmacopoeia;  and,  the  Pulvis  c  Jalappa  compofitns,Pulvi* 
e  Scammonio  compofitus  Pilulx  Alceticse,  Pilule  ex  colocynthide 
cum  Alee,  Pilulae>  e  Jalappa,  aod  Pilulse  Rufi  of  the  Edinburgh 
Pharmacopoeia. 

Any  of  the  foregoing  compofitions,  if  given  in  fufficient  dofes, 
are  very  a&ive  and  bnfk  purges.  Many  more  naight  be  contrived, 
and  on  fome  occafions  may  be  neceffary.  For  procuring  a  briik 
difcharge  of  fluids,  an  addition  of  Calomel  is  remarkably  efficacious 
as  in  the  following  formula  : 
$,.  Scaramon. 

Calomel. 

Crem.  Tart. 
-  Zinzib    a-  a.  p,  oe. 

M.f.  Pulv. 

The  dofc  of  this  powder  is  two  fcruplcs  or  a  drachm,  it  is  extremely 
active  and  ought  to  be  ufed  with  care,  the  patients  being  kept  mo- 
derately warm,  and  drinking  fome  thin  jnucilaginous  liquor  during 
it'*  operation. 


33*  PRACTICE 

tion  and  effects,  when  the  draftic  purgatives  Lav6  beei& 
more  fuccefsful. 

Practitioners  have  long  ago  obferved,  that,  in  the 
employment  of  purgatives,  it  is  requilitc  they  be  re- 
peated after  as  ilrort  intervals  as  the  patient  can  bear ; 
probably  for  chis  reafon*  that  when  the  purging  is  not 
carried  to  the  degree  of  loon  exciting  an  abforption, 
the  evacuation  weakens  the  fyftem,  and  thereby  in- 
creates  the  afflux  of  fluids  to  the  hydropic  parts. 
MDCLXXXiV. 

The  kidneys  afford  a  natural  outlet  for  a  great  part 
of  the  watery  fluids  contained  in  the  blood- vetiHs ;  and 
the  increasing  the  excretion  by  the  kidneys  to  a  conli- 
derable  degree,  is  a  means  as  likely  as  any  other  of 
exciting  an  abforption  in  drppfieal  parts.  It  is  upon 
this  account  that  diuretic  medicines  have  been  al- 
ways properly  employed  in  the  cure  of  dropfy.  The 
various  diuretics  that  rnay  be  employed,  are  enumerat- 
ed in  every  treatifeof  the  Materia  Mcdica  and  of  the 
Practice  ot'Phyfic,  and  therefore  need  not  be  repeated 
here.  It  happens,  however,  unluckily,  that  none  of 
them  are  of  very  certain  operation  ;  neither  is  it  well 
known  why  they  fometimes  fucceed,  and  why  they  fo 
often  fail ;  nor  why  one  medicine  mould  prove  of  fer- 
vice  when  another  does  not.  It  has  been  generally 
the  fault  of  writers  upon  the  Praclice  of  Phyfic,  that 
they  give  us  inllances  of  cafes  in  which  certain  medi- 
cines have  proved  very  efficacious,  but  neglect  to 
tell  us  in  how  many  other  inllances  the  fame  have 
failed. 

MDCLXXXV. 

It  deferves  to  be  particularly  obferved  here,  that 
there  is  hardly  any  diuretic  more  certainly  powerful 
than  a  large  quantity  of  common  water  taken  in  by 
drinking.  I  have  indeed  obferved  above,  in  MDCLVIII. 
that  a  large  quantity  of  water,  or  of  v»atery  liquors, 
taken  in  by  drinking,  has  fometimes  proved  a  caufe  of 

dropfy  ; 


O  F    P  H  Y  S  I  C,  33 


4iOpfy;  and  practitioners  have  been  formerly  fo  much 
afraid  that  watery  liquors  taken  in  by  drinking  might 
run  off  into  the  dropiical  places  and  increafe  the  uif- 
eafe,  that  they  have  generally  enjoined  the  abftaining, 
as  much  as  poflible,  from  fuch  liquors.  Nay,  it  has 
been  further  averted,  that  by  avoiding  this  fupply  of 
exhalation,  and  by  a  total  abftinence  from  drink,  drcpiies 
have  been  entirely  cured.  What  concluiion  is  to  be 
drawn  from  thefe  facts,  is  however,  very  d  .ubtful. 
A  dropfy  arifing  from  a  large  quantity  of  liquids  taken 
into  the  body,  has  been  a  very  rare  occurrence ;  and 
there  are,  on  the  other  hand,  innumerable  inflances  of 
very  large  quantities  of  water  having  been  taken  in  and 
running  off  again  very  quickly  by  ftool  and  urine, 
ivithour  producing  any  degree  of  dropfy.  With  refpect 
to  the  total  ab.ftinence  from  drink,  it  is  a  practice  of 
the  moil  difficult  execution  ;  and  therefore  has  been 
fo  feldom  practiied,  that  \ve  cannot  poflibly  know  how 
far  it  might  prove  effectual.  The  practice  of  giv- 
ing drink  very  fparingly,  has  indeed  been  often  em- 
ployed :  but  in  a  hundred  inflances  I  have  feen  it  car- 
ried to  a  great  length- without  any  manifefl  advantage; 
while,  on  the  contrary,  the  practice  of  giving  drink 
very  largely  has  been  found  not  only  fafe,  but  very  of- 
ten effectual  in  curing  the  difeafe.  The  ingenious  and 
learned  Dr.  Milhnan  has,  in  my  opinion,  be^n  com- 
mendably  employed  in  reitoting  the  piactice  of  giv- 
ing large  quantities  of  watery  liquors  for  the  cure  of 
dropfy.  N  Jt  only  from  the  inftances  he  mentions  from 
his  own  practice,  and  from  that  of  feveral  eminent 
j)hyficians  in  other  parts  of  Europe,  but  alfo  from 
many  inflances  in  the  records  of  phyiic,  of  the  good 
effects  of  drinking  large  quantities  of  mineral  waters 
in  the  cure  of  dropfy,  I  can  have  no  doubt  of  the 
practice  recommended  by  Dr.  Mill  man  being  very  of- 
ten extremely  proper.  '1  apprehend  it  to  be  efpccial- 
]y  adapted  to  thofe  cafes  in  which  the  cure  is  chiefly 

U  u  2  at_ 


' 


343 


PRACTICE 


attempted  by  diuretics.  It  is  very  probable  that  thefe 
medicines  can  hardly  be  carried  in  any  quantity  to 
the  kidneys  without  being  accompanied  with  a  large 
portion  of  water;  and  the  late  frequent  employment 
of  the  cryftals  of  tartar  has  often  mown,  that  the  diu- 
retic effects  of  that  medicine  are  almoft  only  remarka- 
ble when  accompanied  with  a  large  quantity  of  water  ; 
and  that  without  this,  the  diuretic  effects  of  the  medi- 
cine feldom  appear.  I  mail  conclude  this  fubject  with 
obferving,  that  as  there  are  fo  many  cafes  of  d-ropfy 
abfolutely  incurable,  the  practice  now  under  coniide- 
ration  may  often  fail,  yet  in  moft  cafes  it  may  be  fafe- 
ly  tried  ;  and  if  it  appear  that  the  water  taken  in  p^ffcs 
readily  by  the  urinary  fecretion,  and  efpecia%T  that  in 
increafes  the  urine  beyond  the  quantity  of  drink  taken 
in,  the  practice  may  probably  be  continued  with 
great  advantage  :  but,  on  the  contrary,  if  the  urine  be 
not  increafed,  or  be  not  even  in  proportion  to  the 
drink  taken  in,  it  may  be  concluded,  that  the  water 
thrown  in  runs  off  by  the  exhalants,  and  will  augment 
the  difeafe. 

MDCLXXXVI. 

Another  fet  of  remedies  which  may  be  employed 
for  exciting  a  ferous  excretion,  and  thereby  curing 
dropfy,  is  that  of  fud'orifics.  Such  remedies,  indeed, 
have -been  fometimes  employed;  but  however  ufeful 
they  may  have  been  thought,  there  are  few  accounts 
of  their  having  effected  a  cure  ;  and  although  I  have 
had  iorne  examples  of  their  fuccefs,  in  moil  instances 
of  their  trial  they  have  been  ineffectual. 

Upon  this  fubject  it  is  proper  to  take  notice  of  the 
feveral  means  that  have  been  propofed  and  employed 
fur  diffipating  the  humidity  of  the  body  ;  and  parti- 
cularly that  of   heat  externally  applied  to  the  furface 
t.     Of  fuch  applications  I  have  had  no  experience  ; 
their  propriety  and  utility  muft  reft  upon  the  crr- 
ah  :;f  the  authors  who  relate  them.     I  fhallofier  only 

this 


OF    PHY  S  I  C.  341 

this  conjedhire  upon  the  fubjecl :  That  if  fuch  mea- 
fares  have  been  truly  ufeful,  as.it  has  feldom  been  by 
the  drawing  out  of  any  fenfible  humidity,  it  has  pro- 
bably been  by  their  reftoring  the  perforation,  which 
is  fo  often  greatly  diminifhed  in  this  difeafe  ;  or,  per- 
haps, by  changing  the  flate  of  the  ikin,  from  the  im- 
bibing condition  which  is  ^Hedged  to  take  place,  inro 
that  of  perfpiring. 

MDCLXXXVII. 

When,  by  the  feverai  means  now  mentioned,  we 
fhall  have  fucceeded  in  evacuating  the  water  of  drop- 
lies,  there  will  then  cfpccially  be  occafion  for  our  third 
indication ;  which  is,  to  reilore  the  tone  of  the  fyftem, 
the  lofs  of  which  is  fo  often  the  caufe  of  the  difeafe, 
This  indication,  indeed,  may  properly  have  place 
from  the  very  firft  appearance  of  the  difeafe  ;  and  cer- 
tain meafures  adapted  to  this  purpofe  may,  upon  fuch 
firft  appearance,  be  employed  with  advantage.  In 
many  cafes  of  a  moderate  difcafe,  I  am  perfuaded  that 
they  may  obviate  any  future  increafeof  it. 
1V3DCLXXXVIII. 

Thus,  upon  what  is  commonly  the  fir(t  fymptoms 
of  anafarca,  that  is,  upon  the  appearance  of  what  are 
called  Oedematous  Swellings  of  the  feet  and  legs,  the 
three  remedies  of  bandaging,  friction,  and  exercife, 
have  often  been  ufed  with  advantage.  • 
MDCLXXXIX. 

That  fornc  degree  of  external  compreflion  is  fulted 
to  fupport  the  tone  of  the  veffds,  and  particularly  to 
prevent  the  effects  of  the  weight  of  the  blood  in  dilat- 
ing thofe  of  the  lower  extremities,  muft  be  fufficiemly 
evident ;  and  the  giving  that  compreffionby  a  bandage 
properly  applied,  has  been  often  ufeful.  In  apply- 
ing fuch  a  bandage,  care  is  to  be  taken  that  the  com- 
preflion may  never  be  greater  on  the  upper  than  on 
the  lower  part  of  the  limb  ;  and  this,  1  think,  can  hard- 


342  PRACTICE 

ly   ever  be  fo  certainly  avoided,    as  by  employing  a. 
properly  conftructed  laced  flocking. 
MDCXC. 

Friction  is  another  means  by  which  the  action  of 
the  blood- veiTels  may  be  promoted,  and  thereby 
the  ilagnation  of  fluids  in  their  extremities  prevented. 
Accordingly,  theufe  of  the  flefh-brufh  has  often  con- 
tributed to  difcufs  cedematous  fwellings.  It  appears 
to  me,  thai:  friction,  for  the  purpofes  now'  mentioned, 
is  more  properly  employed  in  the  morning,  when  the 
Dwelling  is  very  much  gone  olf,  than  in  the  evening, 
when  any  coniiderable  degree  of  it  has  already 'come 
on.  I  apprehend  alib,  that  friction  being  made  from 
below  upwards  only,  is  more  ufeful  than  when  made 
alternately  upwards  and  downwards.  It  has  been 
common,  inftcad  uf  employing  the  tleih-brufh,  to 
make  n  j  fii£tion  by  warm  and  dry  flannels  ;  and  this 
may  in  iome  c*ies  be  the  mod  convenient :  but  I  can-- 
not perceive  that  the  impregnation  of  thcfe  flannels 
with  certain  dry  fumes  is  of  any  benefit. 
MDCXCI. 

With  refpecc  to  exercife,  I  mtifl  obferve,  that  al- 
though perfons  being  much  in  an  erect  pofture  during 
the  day,  may  feem  to  incrcale  the  fuelling  which 
comes  on  at  night;  yet  as  the  action  of  the  mufcles 
has  a  great  ihare  in  promoting  the  motion  of  the  ve- 
nous blood,  fo  I  am  certain,  that  as  much  exercife  in 
walking  as  the  patient  can  eafily  bear,  will  often  pre- 
vent that  cederr.atous  fwclling,  which  much  Handing^ 
and  even  fitting,  would  have  brought  on. 
MDCXCII. 

Thefe  meafures,  however,  although  they  may  be 
ufeful  at  the  coming  on  of  a  dropfy,  whofe  caufes  are 
not  very  powerful,  will  be  often  infufficient  in  a  more 
violent  difeafe ;  and  fuch  therefore  will  require  more 
powerful  remedies.  Thefe  are,  exercife  and  tonic 
medicines;  which  may  be  employed  both  during  the 

courie 


OF      PHYSIC.  343 

of  the  difeafe  and  efpecially  after  the  water  has 
been  evacuated. 

MDCXCIIL 

Exercife  is  Alfred  to  affift  in  every  function  of  the  ani- 
mal oeconomy>  particularly  to  promote  perfpirationy 
and  thereby  prevent  the  accumulation  of  watery  flu- 
ids in  the  body.  I  apprehend  alfo,  that  it  may  be  the 
moft  effectual  means  for  preventing  the  fkin  from  be- 
ing in  an  imbibing  ftatc;  and,  as  has  been  hinted  a- 
bove  on  the  fubject  of  Emaciation  (MDCVII.)  I  airr  per- 
fuaded,  that  a  full  and  large  perforation  will  always 
be  a  means  of  exciting  abforption  in  every  part  of  the 
fyftem.  Exercife,  therefore,  promifes  to  be  highly 
tifeful  in  dropfy  ;  and  any  mode  of  it  may  be  employ- 
ed that  the  patient  can  moft  conveniently  admit  of.  It 
iliould,  however,  always  be  as  much  as  he  can  eaiily 
bear :  and  in  anafarca,  the  fhare  which  the  exercife  of 
mufcles  has  in  promoting  the  motion  of  the  venous 
blood,  induces  me  to  think  that  bodily  exercife,  to 
whatever  degree  the  patient  can  bear  it,  will  always 
be  the  moft  ufeful.  From  fome  experience  alfo,  I  am: 
perfuaded,  that  by  exercife  aloner  employed  early  in 
the  difeafe,  many  dropfies  may  be  cured. 
MDCXCIV. 

Befides  exercife,  various  tonic  remedies  are  properly 
employed  to  reftore  the  tone  of  the  fyflem.  The 
chief  of  thefe  are,  chalybcates,  the  Peruvian  bark,  and 
various  bitters.  Thefe  are  not  only  faked  to  reftore 
the  tone  of  the  fyftem  in  general,  but  are  particularly 
ufeful  in  ftrengthening  the  organs  of  digeftlon,  which 
in  .dropfies  are  frequently  very  much  weakened  ;  and 
for  the  fame  purpofe  alfo  aromatics  may  be  frequently 
joined  with  the  tonics. 

MDCXCV. 

Cold  bathing  is  upon  many  occafions  the  moft  pow- 
erful tonic  we  can  employ  ;  but  at  the  beginning  of 
diopfy,- when  the  debility  of  the  fyftem  is  confiderable, 

it 


344  PRACTICE 

it  can  hardly  be  attempted  with  fafety.  After,  li 
ever,  the  water  of  dropfies  has  beenvery  fully  evacuat- 
ed, and  the  indication  is  to  ftrengthen  the  fyftem  for 
preventing  a  relapfe,  cold  bathing  may  perhaps  have  a 
place..  It  is,  at  the  fame  time,  to  be  admitted  with 
caution ;  and  can  fcarcely  be  employed  till  the  fyftem 
has  other  wife  recovered  a  good  deal  of  vigour.  When 
that  indeed  has  happened,  cold  bathing  may  be  very 
ufeful  in  confirming  and  completing  it. 

MDCXCVI. 

In  perfons  recovering  from  dropfy,  while  the  feve- 
ral  means  now  mentioned  for  ftrengthening  the  fyftem 
arc  employed,  it  will  be  proper  at  the  fame  time  to 
keep  conftantly  in  view  the  fupport  of  the  watery  ex- 
cretions ;  and  confequently  the  keeping  up  the  per- 
fpiration  by  a  great  deal  of  exercife,  and  continuing 
the  full  flow  of  the  urinary  excretion  by  the  frequent 
ufe  of  diuretics. 


SECT.         II. 

OF  THE  HYDROTHORAX  OR  DROPSY  OF 
THE    BREAST. 

MDCXCVII. 

THE  preternatural  collection  of  ferous  fluid  in  the 
thorax,  to  which  we  give  the  appellation  of  Hyurotbo- 
rax<,  occurs  more  frequently  than  has  been  imagined* 
Its  prefence,  however,  is  not  always  to  be  very  cer- 
tainly known ;  and  it  often  takes  place  to  a  confident- 
b]e  degree  before  it  be  difcovered. 
MDCXCVIIL 

Thefe  collections  of  v/atery  fluids  in  the  thorax,  arc 

found- 


b  F    PHYSIC,  345 

folind  in  different  fituations.  Very  often  the  water 
is  found  at  the  fame  time  in  both  facs  of  the  pleura, 
but  frequently  in  one  of  them  only.  Sometimes  it  is 
found  in  the  pericardium  alone  ;  but  for  the  moil  part 
it  only  appears  there  when  at  the  fame  time  a  collec- 
tion is  prefent  in  one  or  both  cavities  of  the  thorax. 
In  fome  inilances,  the  collection  is  found  to  be  only 
in  that  cellular  texture  of  the  lungs  which  furrounds 
the  branchiae,  without  there  being  at  the  fame  time 
any  effuiion  into  the  cavity  of  the  thorax. 

Pretty  frequently  the  water  collected  confifts  chief- 
ly of  a  great  number  of  hy  datides  in  different  lituati- 
6ns  ;  fometimes  feemingly  floating  into  the  cavity,  but 
frequently  connected  with  and  attached  to  particular 
parts  of  che  internal  furface  of  the  pleura. 
MDCXCIX. 

From  the  collection  of  water  being  thus  in  various 
fituations  and  circumttances,  fymptoms  arife  which 
are  different  in  different  cafes  ;  and  from  thence  it  be- 
comes often  difficult  to  afcertain  the  prefence  and  na- 
ture of  the  affection.  I  mail,  however,  endeavour 
here  to  point  out  the  moft  common  fymptoms,  and 
efpecially  thofe  of  that  principal  and  moil  frequent 
form  of  the  difeafe,  when  the  ferous  fluid  is  prefent  in 
both  facs  of  the  pleura,  or,  as  we  ufually  ipeak,  in 
both  cavities  of  the  thorax. 

MDCC. 

The  difeafe  frequently  comes  on  with  a  fenfe  of  anx- 
iety about  the  lower  part  of  the  ftcrnum.  This,  be- 
fore it  has  fubiiited  long,  comes  to  be  joined  with 
fome  difficulty  of  breathing  ;  which  at  firft  appears  on- 
ly upon  the  perfon's  moving  a  little  fader  than  ufual, 
upon  his  walking  up  an  activity,  or  upon  his  afcend- 
ing  a  ilair-cafe  :  but  after  fome  time,  this  difficulty  of 
breathing  becomes  more  conitant  and  confiderable, 
efpecially  during  the  night,  when  the  body  is  in  a 
horizontal  iituation.  Commonly,  at  the  fame  time, 

VOL.  II.  X  x 


PRACTICE 

lying  upan  one  fide  is  more  eafy  than  upon  the 
or  perhaps  lying  upon  the  back  more  eafy  than  upon 
either  fide.  Thefe  circum (lances  are  ufually  attended 
with  a  frequent  cough,  that  is  at  firft  dry;  but  which, 
ar'ter  fome  time,  is  accompanied  with  an  expectoration 
of  thin  mucus. 

With  all  thefe  fymptoms,  the  hydrothorax  is  not 
certainly  difcovered,  as  the  fame  fymptoms  often  at- 
tend other  difeafes  of  the  bread.  When,  however, 
along  with  thefe  fymptoms,  there  is  at  the  fame  time 
an  cedematous  f welling  of  the  feet  and  legs,  a  leuco- 
phlegmatic  palenefs  of  the  face,  and  a  fcarcity  of  urine^ 
the  exiftence  of  a  hydrothorax  can  be  no  longer 
doubtful.  Some  writers  have  told  us,  that  fometimes 
in  this  difeafe,  before  the  f  welling'  of  the  feet  comes 
on,  a  watery  f  welling  of  the  fcrotum  appears  :  but  I 
have  never  met  any  inftance  of  this. 

MDCCI. 

Whilft  the  prefence  of  the  difeafe  is  fomewhat  un- 
certain, there  is  a  fymptom  which  fometimes  takes 
place,  and  has  been  thought  to  be  a  certain  character- 
iftic  of  ic ;  and  that  is,  when,  foon  after  the  patient  has 
fallen  afleep,  he  is  fuddenly  awaked  with  a  fenfe  of 
anxiety  and  difficult  breathing,  and  with  a  violent 
palpitation  of  the  heart.  Thefe  feelings  immediately 
require  an  erect  poliure  ;  and  very  often  the  difficulty 
of  breathing  continues  to  require  and  to  prevent  fleep 
for  a  great  part  of  the  night.  This  fymptom  I  have 
frequently  found  attending  the  difeafe ;  but  I  have 
alfo  met  with  feveral  inftances  in  which  this  fymptom 
did  not  appear.  I  mud  remark  further,  that  I  have 
not  found  this  fymptom  attending  the  empyema,  or 
any  other  difeafe  of  the  thorax  ;  and  therefore,  when 
it  attends  a  difficulty  of  breathing,  accompanied  with 
any  the  f  mailed  fydem  of  dropfy,  I  have  had  no  doubt 
in  concluding  the  prefence  of  water  in  the  cheft,  and 

have 


OF    PHYSIC.  347 

have  always  had  my  judgmen/  confirmed  by  the  fymp- 
toms  which  afterwards  appeared. 
MDCCIL 

The  hydrothorax  often  occurs  with  very  few,  of 
almofl  none,  of  the  fymptoms  above  mentioned  ;  and 
is  not,  therefore,  very  certainly  difcovered  till  fome 
others  appear.  The  mod  decifive  iymptom  is  a  fluc- 
tuation of  water  in  the  ched,  perceived  by  the  pati- 
ent hinifelf,  or  by  thephyfician,  upon  certain  motions 
of  the  body.  How  far  the  method  propofed  by  Auen- 
brugger  will  apply  to  afcertain  the  prefence  of  water 
and  the  quantity  of  it  in  the  cheft,  I  have  not  had  oc- 
cafion  or  opportunity  to  obferve. 

It  has  be~n  faid,  ihat  in  this  difeafe  fome  tumour  ap-. 
pears  upon  the  iides  or  upon  the  back ;  but  I  have  not 
met  with  any  iaitance  of  this.  In  one  indance  of  the 
ijifeafe,  I  found  one  fide  of  the  thorax  confiderably  en* 
larged,  the  ribs  (landing  out  farther  on  that  iide  than 
upon  the  other. 

A  numbnefs  and  a  degree  of  palfy  in  one  or  both 
arms,  has  been  frequently  obferved  to  attend  a  hydro* 
thorax. 

Soon  after  this  difeafe  has  made  fome .progrefs,  the 
pulfe  commonly  becomes  irregular,  and  frequently 
intermitting:  but  this  happens  in  fo  many  other  dif« 
eafes  of  the  bread,  that,  unlefs  when.it  is  attended  with 
iome  other  of  the  above  mentioned  fymptoms,  it  can- 
not be  conildered  as  denoting  the  hydrothorax. 
MDCCIII. 

This  difeafe,  as.  other  droplks,  is  commonly  attend- 
ed vvirh  third  and  a  fcarcity  of  unne,  to  be  explained 
in  the  fame  manner  as  in  the  cafe  of  anafarca  (MDC- 
LXXIII.)  The  hydrothorax,  however,  is  form-times 
without  third,  or  any  other  febrile  fyaiptom  ;  although 
I  believe  this  happens  in  the  cafe  of  partial  affections 
only,  or  when  a  more  general  aff?£tion  is  yet  but  in  a 
flight  degree.  In  both  cafes,  however,  and  more  efpe* 

X   x  2  cially 


348  P  R  A  C  T  I  C  E 

cially  when  the  difeafe  is  confiderably  advanced, 
degree  of  fever  is  generally  prefent :  and  I  apprehend 
it  to  be  in  luch  cafe,  that  the  perfons  affeded  are 
more  than  ufually  fenfible  to  col  1,  and  complain  of 
the  coldnefs  of  the  air  when  that  is  not  perceived  by 
other  perfons. 

MDCCIV. 

The  hydrothorax  fome times  appears  alone,  with- 
out any  other  fpecies  of  dropfy  being  prefent  at  the 
fame  time  :  and  in  this  cafe  the  difeafe,  for  the  moft 
part,  is  a  partial  affection,  as  being  either  of  one  fide 
of  the  thorax  only,  or  being  a  collection  of  hydatides 
in  one  part  of  the  cheft.  The  hydrothorax,  however, 
is  very  often  a  part  of  more  univerfal  dropfy,  and  when 
at  the  fame  time  there  is  water  in  all  the  three  princi- 
pal cavities  and  in  the  cellular  texture  of  a  great  part 
of  the  body.  I  have  met  with  feveral  inftances,  in 
which  fuch  univerfal  dropfy  began  firft  by  an  effufion 
into  the  thorax.  The  hydrothorax,  rjowever,  more 
frequently  comes  on  from  an  anafarca  gradually  in- 
creafins;;  and,  as  I  have  faid  above,  the  general  dia- 
thefis  feems  often  to  affect  the  thorax  fooner  than  it 
does  either  the  head  or  the  abdomen, 
MDCCV: 

This  difeafe  feldom  admits  of  a  cure,  or  even  of  alle- 
viation, from  remedies.  It  commonly  proceeds  to, 
give  more  and  more  difficulty  of  breathing,  till  the 
action  of  the  lungs  be  entirely  interrupted  by  the 
quantity  of  water  effufed  ;  and  the  fatal  event  fre- 
quently happens  more  fuddenly  than  was  expe&ed. — • 
In  many  of  the  inftances  of  a  fatal  hydrothorax,  I  have 
remarked  a  fpitting  of  blood  to  come  on  feveral  days 
before  the  patient  died. 

MDCCVI. 

The  raufe  of  hydrothorax  is  often  manifeflly  one  or 
other  of  the  general  caufes  of  dropfy  pointed  out  p.- 
toove :  but  what  it  is  that  determines  thefe  general 

caufes 


OF     PHYSIC.  349 

eaufes  to  aft  more  efpecially  in  the  thorax,  and  parti- 
cularly what  it  is  that  produces  the  partial  collections 
that  occur  there,  I  do  not  find  to  beeafily  aicertained. 

MDCCVII. 

From  what  has  been  faid  above,  it  will  be  evident, 
that  the  cure  of  hydrothorax  muft  be  very  much  the 
fame  with  that  of  anafarca  ;  and  when  the  former  is 
joined  with  the  latter  as  an  effect  of  the  fame  general 
diathelis,  there  can  be  no  doubt  of  the  method  of  cure 
being  the  fame  in  boch.  Even  when  the  hydrotho- 
rax  is  alone,  and  the  difeafe  partial,  from  particular 
caufes  acting  in  the  thorax  only,  there  can  hardly  be 
any  other  meafures  employed,  than  the  general  ones 
propofed  above.  There  is  only  one  particular  mea- 
lurc  adapted  to  the  hydro  thorax ;  and  that  is,  the 
drawing  off  the  accumulated  waters  by  a  paracenteiis  of 
the  thorax. 

MDCCVlli. 

To  what  cafes  this  operation  may  be  moft  properly 
adapted,  I  find  it  difficult  to  determine.  That  it  may 
be  executed  with  fafety,  there  is  no  doubt ;  and  that 
it  has  been  fometimes  praftifed  with  fuccefs,  fcems  to 
be  very  well  vouched*.  When  the  difeafe  depends 

upon 
i 

*  In  the  memoirs  of  the  Academy  of  Sciences  at  Paris,  for  1703. 
M  .  Du  Verney  relates  the  cafe  of  a  woman  who  had  both  an  Af  • 
cites  and  Hydrothorax.  Ke  firft  emptied  the  abdomen  by  tap- 
ping, and  a  few  days  afterwards,  he  pierced  the  thorax  with  a  tro- 
char,  near  to  the  fpine,  between  thefeconei  and  third  falfe  ribs  ;  by 
which  opening  he  drew  off  a  confiderable  quantity  of  water  ;  the  o- 
peration  gave  immediate  relief  to  the  patient,  and  (he  was  able  to 
return  to  her  ordinary  employments  in  about  a  month's  time. 

Bianchi  auo  relates  a  fuccefsful  operation  of  tapping  the  thorax  ; 
but  he  feems  to  be  timid  in  his  practice,  and  confefTes  that  he  has 
feldom  ventureu  on  the  operation. 

The  practice  ef  evacuating  water  contained  in  the  thorax  by  an 
inciiion  is  very  old.  We  find  it  reoommended  by  Hippocrates, 
with  particular  directions  for  performing  the  operation,  in  his  fecond 
book  orrdifeafes.  See  the  Geneva  Edition  ofFoefius'a  Hippocrates, 
pg-483- 


35®  PRACTICE 

upon  a  general  hydropic  diathefis,  it  cannot  alone 
prove  a  cure,  but  may  give  a  temporary  relief ;  and 
when  other  remedies  feern  to  he  employed  wirh  advan^ 
tage,  the  drawing  off  the  water  may  very  much  fa- 
vour a  complete  cure.  I  have  not,  however,  been  fo 
fortunate  as  to  fee  it  practifed  with  any  fuccefs  ;  and 
even  where  it  was  moil  promifing,  that  is,  in  cafes  of 
partial  affection,  my  expectations  have  been  difappomt- 
ed  from  it. 


SECT.         Ill, 


OF  ASCITES,  OR  DROPSY  OF  THE  LOWER 

BELLY. 


MDCCIX. 

Tim  name  of  Afcites  is  given  to  every  collection  of 
\vaters  caufing  a  general  fwelling  and  diftenfion  of  the 
lower  belly  :  and   fuch   collections  are  more  frequent 
than,  thofe  which  happen  in  the  thorax. 
MDCCX, 

The  collections  in  the  lower  belly,  like  thofe  of  the 
thorax,  are  found  in  different  fituations.  Moft  com- 
monly they  are  in  thefac  of  the  peritonaeum,  or  gene- 
ral cavity  of  the  abdomen  :  but  they  often  begin  by 
facs  formed  upon,  and  connected  with,  one  or  other 

of 

That  the  pra&ice  was  frequently  attended  with  fuccef?,  in  thofe 
early  ages,  is  fufficiently  evident  by  the  context ;  for  Hippocrates, 
after  defcribing  the  operation,  and  the  fubfequent  management  of 
the  patient  fays,  "  If  pus  appear  on  the  plaiiler  covering  the  wound; 
"  on  the  fifth  .day  after  the  operation,  the  patient  generally  reco- 
*'  vers  j  if  not,  he  is  feized  with  a  cough  and  thirft,  and  dies." 


0  F     P  H  Y  S  1  C.  351 

of  the  vifcera  ;  and  perhaps  the  moil  frequent  in- 
ilances  of  this  kind  occur  in  the  ovaria  of  females. 
Sometimes  the  water  of  afcites  is  found  entirely  with- 
out the  peritonaeum,  and  between  this  and  the  abdomi- 
nal mufcles, 

MDCCXI. 

Thefe  collections  connected  with  particular  vifcera, 
and  thofe  formed  without  the  peritonaeum,  form  that 
difeafe  which  authors  have  temied  the  encyfled  dropfy, 
or  hydrops  faccatus.  Their  precife  feat,  and  even 
their  exiitence,  is  very  often  difficult  to  be  afcertain- 
ed.  They  are  generally  formed  by  collections  of  hy- 
datides. 

MDGCXII. 

In  the  mofl  ordinary  cafe,  that  of  abdominal  drop- 
fy, the  fuelling  at  firft  is  in  lome  meafure  over  the 
whole  belly,  but  generally  appears  moil  confiderable 
in  the  epigafhium.  As  the  difeafe,  however,  advanc- 
es, the  f  .veiling  becomes  more  uniform  over  the  whole. 
The  diftenfion  and  fenfe  of  weight,  though  confider- 
able,  vary  a  liiue  according  as  the  poilure  of  the  body 
is  changed  ;  the  weight  being  felt  the  moft  upon  the 
lideon  which  the  patient  lies,  while  at  the  fame  time 
on  the  oppoiite  fide  the  difleniion  becomes  fomewhat 
lei's.  In  almcft  all  the  inftances  of  afcites,  the  fluctu- 
ation of  the  water  within,  may  be  perceived  by  the 
practitioner's,  feeling,  and  fometimes  by  his  hearing. 
This  perception  of  fluctuation  does  not  certainly  dif- 
tingiiiih  the  different  ftates  of  dropiy  ;  but  ferves  very 
well  to  diftinguim  dropfy  from  tympanites,  from  cufes 
of  phyfconia,  and  from  the  ftate  of  pregnancy  in 
women. 

MDCCX1II. 

As  afcites  frequently  occurs  when  no  other  fpeci  s 
of  dropfy  does  at  the  fame  time  appear  ;  but  fome- 
times the  afcites  is  a  part  only  or'  univerfal  dropiy. 
In  this  cafe,  it  ufually  comes  on  in  confequence  of  \\\\ 

a  11:  i- 


35*  P  R  A  C  T  1C  E 

anafurca,  gradually  increafing  ;  but  its  being  joined 
with  anafarca,  does  not  always  denote  any  general  dia- 
theiis,  us  for  the  rnoft  part  an  afcites  fooner  or  later  oc- 
caiions  cedeniatous  f \veilings  of  the  lower  extremities. 
When  the  collection  of  water  in  the  abdomen,  from 
whatever  caufe,  becomes  confidenible,  it  is  always  at- 
tended with  a  difficulty  of  breathing  ;  but  this  fymp- 
tom  occurs  often  when,  at  the  fame  time,  there  is  no 
water  in  the  thorax.  The  afcites  is  fometimes  unac- 
companied with  any  fever  ;  but  frequently  there  is 
more  or  lei's  of  fever  preient  with  it.  The  difeafe  is 
never  coniiderablc,  without  being  attended  with  thirlt 
and  fcarcity  of  urine. 

MDCCXIV. 

In  the  diagnoils  of  afcites,  the  greatefl  difficulty  that 
occurs,  is  in  difcerning  when  the  water  is  in  the  cavity 
of  the  abdomen,  or  when  it  is  in  the  different  dates  of 
encyited  dropfy  above  mentioned.  There  is,  perhaps, 
no  certain  means  of  afcertaining  this  in  all  cafes  ;  but 
in  many  we  may  attempt  to  form  fome  judgment  with 
regard  to  it. 

When  the  antecedent  circumftances  give  fufpicion 
of  a  general  hydropic  diathefis ;  when  at  the  fame 
time  forne  degree  of  dropfy  appears  in  other  parts  of 
the  body ;  and  when,  from  its  firfl  appearance,  the' 
fwelling  has  been  equally  over  the  whole  belly,  we  may 
generally  prefume  that  the  water  is  in  the  cavity  of 
the  abdomen.  But  when  an  afcites  has  not  been  pre- 
ceded by  any  remarkable  cacheclic  ftateof  the  fyftem, 
and  when  at  its  beginning  the  tumour  and  tenlion  had 
appeared  in  one  part  of  the  belly  more  than  ano- 
ther, there  is  reafon  to  fufpecl  an  encyfted  dropfy. 
Even  when  the  teniion  and  tumour  of  the  belly  have 
become  general  and  uniform  over  the  whole  ;  yet  if 
the  fy item  of  the  body  in  general  appear  to  be  little 
afleded  ;  if  the  patient's  ftrength  be  little  impaired  ; 
if  the  appetite  continue  pretty  en-tire,  and  the  natural 

fleep 


u  F    PHYSIC.  353 

Ikep  be  little  interrupted  ;  it*,  the  rnenfes  in  females 
continue  to  ilovv  as'  ufual;  if  there  be  yet  no  anafarca  ; 
or,  though  it  may  lave  already  uken  place,  if  it  be 
ftill  confined  to  the  lower  extremities,  and  there  be  110 
leucophlegmatic  palenels  or  tallow  colour  in  the  coun- 
ionance;  if  there  be  no  icvvr,  nor  ib  much  third,  01* 
fcarcity  of  urine,  as  occur  in  ;i  more  general  afieclion; 
then,  according  as  more  of  thefe  diilcrenc  circiumianc- 
es  take  place,  there  will  be  the  ftronger  ground  for 
fuppofing  the  afcites  to  be  of  the  encyfled  kind. 

The  chief  exception  to  be  made  from  this  as  a  gene- 
ral rule,  will,  in  iny  opinion,  be  when  the  afcites  may 
with  much  probability,  be  prefumed  to,  have  come  ou 
in  confequence  of  a  fcirrhous.  liver*;  which,  I  appre- 
hend, mayoccafion  a  collection  of  water  in  the  cavity 
of  the  abdomen,  while  the  general  fyftem  of  the  body 
may  not  be  otherwife  much  atlecled. 

MDCCXV. 

With  refpe£t  to  the  cure  of  afcites  when  of  the  en- 
cyfled kind,  it  does  not,  fo  far  as  I  know,  admit  of 
any.  When  the  collection  of  water  is  in  the  abdomi- 
nal cavity  alone,  without  any  other  fpecies  of  ciropfy 
pTefent  at  the  fame  time,  I  apprehend  the  afcites  will 
always  be  of 'difficult  cure  ;  for  it  may  be  prefumed  to 
depend  upon  a  fcirrhofity  of  the  liver,  or  other  confi- 
derable  affe&ion  of  the  abdominal  vifcera,  which.  I 
conceive  to  be  of  very  difficult  cure,  and  therefore 
the  afcites  depending  upon  them.  At  the  fame  time, 
iuch  cafes  may  often  admit  of  a  temporary  relict 
the  paracenteiis. 

MDCCXVI 

When  the  afcites  is  a  part  of.  univerfal  dropfy,  it 
in  ay,  as  far  as  other  cafes  of  that  kind  can,  admit  of  a 
cure;  and  it  will  be  obvious,  that  fuch  u  cure  mail  be 
6Dta.med  by  the  fame  means  as  above  propoied  for  the 
cure  of  general  aiiaiarca*. 

It  frequently    happens  that  the  afcices  is  attend e:i 
VOL.  II.  Y  y  with 

*  See  the  notes  on  Article  1683, 


354  PRACTICE 

with  a  diarrhoea ;  and,. in  that  cafe,  does  not  admit  of 
the  ufe  of  purgatives'  fo  freely  as  cafes  of  anafarca 
commonly  do.  It  is  therefore  often  to  be  treated  by 
diuretics  almoft  alone. 

The  diuretics  that  may  be  employed,  are  chiefly 
thofe  above-mentioned  ;  but  in  afcites,  a  peculiar  one 
has  been  found  out.  It  is  a  long-continued  gentle 
fridion  of  the  ikin  over  the  whole  of  the  abdomen, 
by  the  fingers  dipped  in  oil.  This  has  fometimes  been 
ufeful  in  exciting  an  increafed  flow  of  urine  ;  but  in 
mod  of  the  trials  of  it  which  I  have  known  made,  it 
has  failed  in  producing  that  effect. 
MDCCXVII. 

The  afcites  admits  of  a  particular  means  for  imme- 
diately drawing  off  the  collected  waters  :  and  that  is 
the  well-known  operation  of  the  paracentefis  of  the 
abdomen.  In  what  circumftances  of  aicites  this  ope- 
ration can  mo  ft  properly  be  propofed,  it  is  difficult  to 
determine  ;  but,  fo  far  as  I  can  judge,  it.  muil  be  re- 
gulated by  very  much  the  fame  considerations  as  thofe 
above-mentioned  with  regard  to  the  paracentefis  of 
the  thorax. 

The  manner  of  performing  the  paracentefis  of  the 
abdomen,  and  the  precautions  to  be  taken  with  refpect 
to  it,  are  now-fo  commonly  known,  and  delivered  in 
fo  many  books,  that  it  is  altogether  unneceffary  for 
me  to  offer  any  directions  upon  that  fubject  here ; 
efpecially  after  the  full  and  judicious  information  and 
directions  given  by  Mr.  BELL,  in  the  fecond  volume 
of  his  Syjletn  of  Surgery. 


OF    P  H  Y  S  I  C,  355 

CHAP.        IV. 

OF  GENERAL  SWELLINGS,  ARISING  FROM 
AN  INCREASED  BULK  OF  THE  WHOLE 
SUBSTANCE  OF  PARTICULAR  PARTS. 

MDCCXVIII. 

UPON  the  fubjecb  of  this  chapter,  feveral  nofolo- 
gical  difficulties  occur,  and  particularly  with  re- 
fpecl:  to  admitting  the  Pbyfionia  into  the  order  of  Ge- 
neral Swellings.  At  p:  vever,  it  is  not  necef- 
fary  for  me  to  difcufs  this  point,  as  I  am  here  to  omit 
entirely  the  conflderatipn  of  Pbyfconia;  both  becaufe 
it  can  feldom  admit  of  any  fuccefsful  pra&ice,  and 
bccaufe  I  cannot  deliver  any  thing  uleful  either 
with  regard  to  the  pathology  or  practice  in  fuch  a  difr 
cafe. 

MDCCXIX. 

The  only-other  genus  of  difeafe  comprehended  un- 
der the  title  oi  the  prefent  chapter,  is  the  Rachitis ; 
and  this  being  both  a  proper  example  of  the  clafs  of 
Cachexy,  and  of  the  order  of  Intumefcentics  or  General 
Swellings,  I  fhall  offer  fome  observations  with  regard 
to  it. 

OF  RACHITIS,  OR  RICKETS. 

MDCCXX. 

THIS  difeafe  has  been  fuppofed  to  have  appeared 
only  in  modern  times,  and  not  above  two  hundred 
years.  This  opinion,  notwithftanding  it  has  been 
maintained  by  perfons  of  the  moil  refpeclable  authori- 
ty*, appears  to  me,  from  many  coniiderations,  impro- 
bable j  but  it  is  a  point  of  too  little  confequence  to 

Y  y  '2  detain 

*  Boerhaave  was  of  this  opinion,  fee ..Van  Swieten's  commentary 
en  Aphorii'm  1482. 


356  PRACTICE 

fletain  my  readers  here.  The  only  application  of  u 
which  deferves  any  notice  is,  that  it  has  led  to  a  no- 
tion of  the  difeafe  having  arifen  from  the  lues  venera, 
which  had  certainly  made  its  firft  appearance  in  Eu- 
rope not  very  long  before  the  date  commonly  affigned 
for  the  appearance  of  rachitis  :  but  I  ihali  hereafter 
{how,  that  the  fuppofed  connection  between  the  Si- 
phylis  and  Rachitis  is  without  foundation*. 

MDCCXXI. 

In  delivering  the  hiftory  of  the  Rickets,  I  muft,  in 
the  firft  place,  obferve,  that  with  refpeci:  to  the  ante- 
cedents of  the  difeafe,  everything  to  be  found  in  au- 
thors upon  this  fubjecl:,  appears  to  me  to  reft  upon  a 
very  uncertain  foundation.  In  particular  with  refpeci 
to  the  ftate  of  the  parents  whole  offspring  become  af- 
fected with  this  difeafe,  I  have  met  with  many  inftan- 
ces  of  it  in  children  from  feemingly  healthy  pa- 
rents ;  and  have  met  likewife  with  many  inttances 
of  children  who  never  became  affected  with  it,  al- 
though born  of  parents  who  according  to  the  common 
accounts,  iliould  have  produced  a  rickety  offspring  : 
fo  that,  even  making  allowance  for  the  uncertainty  of 
fathers,  I  do  not  find  the  general  opinion  of  authors 
upon  this  fubjecl:  to  be  properly  fupportcd. 

MDCCXXII. 

The  difeafe,  however,  may  be  juitly  confidered  as 
proceeding  from  parents;  for  it  often  appears  in  a 
great  number  of  the  fame  family  ;  and  my  obfervation 
leads  me  to  judge,  that  it  originates  more  frequently 
from  mothers  than  from  fathers.  So  far  as  I  can  refer 
the  difeafe  of  the  children  to  the  ftate  of  the " parents j 
it  has  appearrd  to  me  moft  commonly  to  arife  from 
icrne  weaknefs,  and  pretty  frequently  from  a  fcrop.hu- 
lous  habit,  in  the  mother.  To  conclude  the  fubjecT, 
I  mud  remark,  that  in  many  cafes  I  have  not  been 
able  to  difcem  the  condition  of  the  parents,  to  which 
I  could  refer  it. 

When 
*  See  Article  1717. 


OF      PHYSIC.  357 

When  nurfes,  other  than  the  mothers,  have  bern 
employed  to  fuckle  children,  it  has  been  fuppofed  that 
fuch  nurfes  have  frequently  given  occafion  to  the  dif- 
cafe*  ;  and  when  nurfes  have  both  produced  and  have 
fuckled  children  who  became  rickety,  there  may  be 
ground  to  fufpecl  their  having  occaiioned  the  diieafe 
in  the  children  of  other  perfons  :  but  I  have  had  few 
opportunities  of  afcertaining  this  matter.  It  has  in 
forne  meafure  appeared  to  me  that  thofe  nurfes  are  moil: 
likely  to  produce  this  difeafe,  who  give  infants  a  large 
quantity  of  very  watery  milk,  and  who  continue  to 
fuckle  them  longer  than  the  ufual  time.  Upon  the 
whole,  however,  I  am  of  opinion,  that  hired  nurfes  fel- 
,dom  occafiori  this  difeafe.,  unlefs  when  a  predifpofitiprt 
to  it  has  proceeded  from  the  parents. 

MDCGXXIIL 

With  regard  to  the  other  antecedents,  which  have 
been  ufually  enumerated  by  authors  as  the  remote 
caufes  of  this  difeafe,  I  judge  the  accounts  given  to  be 
extremely  fallacious  ;  and  I  am  very  much  per'Iuadcc!, 
that  the  circumftanccs  in  the  rearing  of  children,  have 
lefs  efredl  in  producing  rickets  than  has  been  imagin- 
ed. It  is  indeed  not  unlikely,  that  fome  of  thefe  cir- 
cumftances  mentioned  as  remote  cauies  may  favour, 
while  other  circumftances  may  refift,  the  coming  on 
of  the  difeafe  ;  but  at  the  fame  time,  I  doubt  if  any  of 
the  former  would  produce  it  where  there  was  no  pre- 
difpontion  in  the  child's  original  conltitution.  This 
opinion  of  the  rcmore  caufes,  I  have  formed  from  ob- 
ferving,  that  the  difeafe  comes  on  when  none  of  thefe 
had  been  applied  ;  and  more  frequently  that  many  or" 
them  had  been  applied  without  occaiioning  the  dif- 
eafe. Thus  the  learned  ZEVIANI  alledges,  that  the 

di  6 

*  This  opinion  was  held  by  Boerliaave,  and  notTrithilanciin^  what 
the  Author  fays  at  the  end  of  this  paragraph,  the  opinion  is  certain- 
ly founded  on  experience. 


353  PRACTICE 

difeafe  is  produced  by  an  acid  from  the  milk  with 
\vhich  a  child  is  fed  for  the  firft  nine  months  of  its 
life  ;  but  almoft  air  children  are  fed  with  the  fame 
food,  and  in  which  alfo  an  acid  is  always  produced  ; 
while,  at  the  lame  time,  not  one  in  a  thoufasd  of  the 
infants  fo  fed  becomes  affected  with  the  rickets.  If, 
therefore,  in  the  infants  who  become  affectect  with  this 
difeafe,  a  peculiarly  noxious  acid  is  produced,  we  muft 
feek  for  fome  peculiar  caufe  of  its  production,  either 
in  the  quality  of  the  milk,  or  in  the  conftitution  of 
the 'child ;  neither  of  which,  however,  Mr.  Zeviani 
has  explained.  I  cannot  indeed  believe  that  the  or- 
dinary acid  of  milk  has  any  ihare  in  producing  this 
difeafe,  becaufe  1  have  known  many  inftances  of  thq 
acid  being  produced  and  occaiioning  various  diforders, 
without,  however^  its  ever  producing  rickets. 

Another  of  the  remote  caufes  commonly  affigned,  is. 
the  child  being  fed  with  unfermented  farinaceous 
food.  But  over  the  whole  world  children  are  fed 
with  fuch  farinacea,  while  the  difeafe  of  rickets  is  a 
rare  occurrence  :  and  I  have  known  many  instances 
where  children  have  been  fed  with  a  greater  than 
ufual  proportion  of  fermented  farinacea,  and  alfo  a 
greater  proportion  of  animal  food,  without  thefe  pre- 
venting the  difeafe.  In  my  apprehenfion,  the  like 
obfervations  might  be  made  with  refpedt  to  moft  of 
the  circuinftaaces  that  have  been  mentioned  as  the  re- 
mote caufes  of  rickets. 

MDCCXXIV. 

Having  thus  offered  my  opinion  concerning  the  fup- 
pofed  antecedents  of  this  difeafe,  I  proceed  now  to 
mention  the  phenomena  occurring  after  it  has  actual- 
ly come  on*. 

The  difeafe  feldom  appears  before  the  ninth  month, 

and 

*  This  admirable  defcription  of  the  difedfe  merits  the  peculiar 
attention  of  the  young  practitioner. 


OF    PHYSIC. 

and  feldom  begins  after  the  fecond  year,  cf  a  child's 
age.     In  the  interval  between  thefe  periods,  the  ap- 
pearance of  the  difeafe  is  fometimes  fooner,  fometimes 
later ;  and  commonly  at  firft  the   difeafe  comes  on 
flowly.     The  firft   appearances  are,    a  flaccidity  of 
the  flefh,  the  body  at  the  fame  time  becoming  leaner, 
though  food  be  taken  in  pretty  largely.     The  head 
appears  large  with  refpect  to  the  body ;  with  the  fon- 
tanelle,  and  perhaps  the  futures,  more  open  than  ufual 
in  children  of  the  fame  age,     The  head  continues  to 
grow  larger  ;  in  particular,  the  forehead  becoming  un- 
ufually! prominent ;  and  at  the  fame  time  the  neck  con- 
tinues (lender,  or  feems  to  be  more  fo,  in  proportion  to 
the  head.     The  dentition  is  flow,  or  much  later  than 
ufual ;  and  thofe  teeth  which  come  out,  readily  become 
black,   and  frequently  again  fall  cut.     The  ribs  lofe 
their  convexity,  and   become  flattened  on  the  fides  ; 
while  the  fternum  ispufhed  outward,  and  forms  a  fort 
of  ridge.     At  the  fame  time,  or  perhaps  fboner,  the 
epiphyfes  at  the  feveral  joints  of  the  limbs  become 
fwelled  ;  while   the  limbs  between  the  joints  appear, 
or  perhaps  actually  become,  moreflender.     The  bones 
feem  to  be  every  where  flexible,   becoming  varioufly 
diftorted;  and  particularly  the  fpine  of  the  back  be- 
coming incurvated  in  different  parts  of  its  length.     If 
the  child,  at  the  fame  time  the  difeafe  comes  on,  had 
acquired  the  power  of  walking,  it  becomes  daily  more 
1  feeble  in  its  motions,  and  more  averfe  to  the  exertion 
of  them,  lofmg  at  length  the  power  of  walking  alto- 
gether.    Whilft  thefe   fymptoms  go  on    increafing, 
the  abdomen  is  always  full,  and.preternaturally  tumid. 
The  appetite  is  often  good,  but  the  ftools  are  general- 
ly frequent  and  loofe.     Sometimes  the  faculties  of  the 
mind  are  impaired,   and  ftupidity  or  fatuity  prevails  ; 
but  commonly  a  premature  fenfibility  appears,   and 
they  acquire  the  faculty  of  fpecch  fooner  than  i 
At  the  firft  coming  on  of  the  difeafe,  there  is  general- 
ly 


P  R  A  C  T  I  C  E 


•o  fever  attending  it :  but  it  feldoni  continues  L, 
a  frequent    pulie,    and   other  febrile  lymptoms, 


ly  n  j 
lill 

come  to  be  conllantly  prefent.  With  ihefe  iymptoms1 
ihe  difeafe  proceeds,  and  continues  in  fome  initances 
for  fome  years ;  but  very  often,  in  the  courfe  of  that 
time,  the.  difeafe  ceafes  to  advanee,  and  the  health  is 
entirely  eilabliilied,  except  that  the  diitorted  limbs, 
produced  during  the  difeafe,  continue  for  the  reft  of 
life.  In  other  cafes,  however,  the  difeafe  proceeds  in- 
creafmp;,  till  it  has  affected  aimofl  every  function  of 
the  animal  oeconomy,  and  at  length  terminates  in 
death.  The  variety  of  fymptoms  which  in  fuch  cafes 
appear,  it  does  not  feem  necqlFary  to  enumerate,  as 
they  are  not  eiTential  to  the  conftitution  of  the  difeafe, 
but  are  merely  confequences  of  the  more  violent  con- 
ditions of  it.  In  the  bodies  of  thofe  who  have  died, 
various  morbid  affections  have  been  discovered  in  the 
internal  parts.  Mofl  of  the  vifcera  of  the  abdomen 
have  been  found  to  be  preternaturally  enlarged.  The 
kings  have  alfo  been  found  in  a  morbid  itate,  feeming- 
ly  from  fome  inflammation  that  had  come  on  towards 
the  end  of  the  difeafe.  The  "brain  has  been  common- 
ly found  in  a  flaccid  ftate,  with  effuiions  of  a  ferons 
iiuid  into  its  cavities.  Very  univeriklly  the  bones 
have  been  found  very  foft,  and  fo  much  foftened  as  to 
readily  cut  by  a  knife.  The  fluids  have  been  always 
found  in  a  diffolved  ilate,  and  the  mufcular  parts  very 
foft  and  tender  ;  and  the  whole  of  the  dead  body  with- 
out any  degree  of  that  rigidity  which  is  fo  common 
in  almoft  all  others. 

MDCCXXV. 

From  thefe  circumftances  of  tiic  difeafe,  it  fcerasto 
coniiit  in  n  deficiency  of  that  matter  wliich  iliould 
.ithe  Iblid  parts  of  the  body.     This  ef pec  idly  ap- 
pears in  the  fauity  ilaie  of  oiiificarion,    ieemin^ty  de- 
j-;"ndJnt^   upon   the  deficiency  of  that  matter  which 

ili'juld  be  denolired  in  the  membranes  which  are  del- 

,  •      i 
tinea 


OF      PHYSIC,  361 

ftined  to  become  bony,,  and  fhould  give   them  their 
due  firmnefs  and  bony  hardnefs.     It  appears  that  this 
matter  is  not  fupplied  in  due  quantity  ;  but  that,  in 
place  of  it,  a  matter  fitted  to  increafe  their  bulk,  par- 
ticularly  in  the  epiphyfes,   is    applied  too    largely* 
What  this  deficiency  of  matter  depends  upon,  is  diffi- 
cult to  be  afcemined.     It  may  be  a  fault  in  the  organs 
of  digetlion  and  aflimilation,    which  prevents  the  flu- 
ids in  general   from  being  properly  prepared :  or  it 
may  be  a  fault  in  the  organs  of  nutrition,  which  pre- 
vents the  fecretion  of  a  proper  matter  to  be  applied. 
With  refpedt  to  the  latter,  in  what  it  may  confiit,  I 
am  entirely  ignorant,    and  cannot  even  difcern  rhat 
fuch  a  condition  exiils  :   but  the  former  caufe,  both 
in  its  nature  and  exigence,  is  more  readily  perceived ; 
and  it  is  probable  that  it  has  a  conficlerable  influence  in 
the  matter ;  as  in  rachitic  perfons  a  thinner  (late  of  the 
blood,  both  during  life  and  after  death,  fo  commonly 
appears.     It  is  this  Hate  of  the  fluids,  or  a  deficiency 
of  bony  matter  in  them,  that  I  coniider  as  the  proxi- 
mate caufe  of  the  difeafe  ;  and  which  again  may  in 
ibme  meafure  depend  upon  a  general  laxity  and  debi- 
lity of  the  moving  fibres  of  the  organs  that  perform 
the  fun&ionsof  digeflion  and  aflimiiation. 
MDCCXXVI. 

There,  is,  however,  fome  thing  ftill  wanting  to  explain, 
why  thefe  circumftances  difcover  themfelves  at  a  par- 
ticular time  of  life,  and  hardly  ever  either  before  or 
after  a  certain  period;  and  as  to  this  I  would  offer  the 
following  conjectures.  Nature  having  intended  that 
human  life  fhould  proceed  in  a  certain  manner,  and 
that  certain  functions  mould  be  exercifed  at  a  certain 
period  of  life  only  ;  fo  it  has  generally  provided,  that 
at  that  period,  and  not  fooner,  the  body  fhould  be  fit- 
ted for  the  exercife  of  the  functions  fuited  to  it.  To 
apply  this  to  our  prefent  fubject,  Nature  feems  to  ruve 
intended  that  children  fhould  walk  only  at  twelve 

VOL.  If.  Z  z  mcnrhs 


PRACTICE 

months  old ;  .and  accordingly  has  provided,  that  againft 
that  age,  and  no  fooner,  a  matter  fhould  be  prepared 
fit  to  give  that  firm nefs  to  the  bones  which  is  neccffary 
to  prevent  their  bending  too  eafily  under  the  weight 
of  the  body.  Nature,  however,  is  not  always  fteady 
and  exafh  in  executing  her  own  purpofes  ;  and  if 
therefore  the  preparation  of  bony  matter  (hall  not  have 
been  made  againft  the  time  there  is  particular  occafi- 
on  for  it,  the  difeafe  of  rickets,  that  is,  of  foft  and  flex- 
ible bones,  rnufl  ct)me  on  ;  and  will  diicover  itfelf  about 
the  particular  period  we  have  mentioned.  Further,  it 
will  be  equally  probable,  that  if  at  the  period  menti- 
oned  the  bones  ihall  have  acquired  their  due  firmnefs, 
and  that  nature  goes  on  in  preparing  and  fupplying  the 
proper  bony  matter,  it  may  be  prefumed,  that  againit 
the  time  a  child  is  two  years  old,  fuch  a  quantity  of 
bony  matter  will  be  applied  as  to  prevent  the  bones 
from  becoming  again  foft  and  flexible  during  the  reft 
of  life  ;  unlefs  it  happens,  as  indeed  it  fometimes  does, 
that  certain  caufes  occur  to  wafh  out  again  the  bony 
matter  from  the  membranes  in  which  it  had  been  de- 
pofited.  The  account  I  have  now  given  of  the  period 
at  which  the  rickets  occur,  feems  to  confirm  the  opi- 
nion of  its  proximate  caufe  being  a  deficiency  of  bo- 
ny matter  in  the  fluids  of  the  body. 
MDCCXXVII. 

It  has  been  frequently  fuppofed,  that  a  fiphylitie 
taint  has  a  ihare  in  producing  rickets  ;  but  fuch  a 
fuppofition  is  altogether  improbable.  If  our  opinion 
of  the  rickets  having  exifted  in  Europe  before  the  fi- 
phylis  was  brought  into  it,  be  well  founded,  it  will 
then  be  certain  that  the  difeafe  may  be  occafioned 
without  any  fiphylitie  acrimony  having  a  ihare  in  its 
production.  But  further,  when  a  fiphylitie  acrimony 
is  tranfmitred  from  the  parent  to  the  offspring,  the 
fymptoms  do  not  appear  at  a  particular  time  of  life  on- 
ly, and  commonly  more  early  than  the  period  of  rick- 
ets : 


OF    PHYSIC.  363 

et&;  the  fymptoms  alfo  are  very  different  from  thofe 
of  rickets,  and  unaccompanied  with  any  appearance  of 
the  latter  :  and,  laflly,  the  fymptoms  of  iiphylis  are 
cured  by  means  which,  in  the  cafe  of  rickets,  have  ei- 
ther no  eitccl:,  or  a  bad  one.  It  may  indeed  poilibly 
happen,  that  Iiphylis  and  rickets  may  appear  in  the 
fame  perfon  ;  but  it  is  to  be  confideied  as  an  accident- 
al complication  :  and  the  very  few  inftanccs  of  it  that 
have  occurred,  are  by  no  means  fufficient  to  eita- 
blifh  any  neceflary  connection  between  the  two  dif- 


MDCCXXVIIL 

With  refpeel:  to  the  deficiency  of  bony  matter, 
which  I  coniider  as  the  proximate  ca-ule  of  rickets, 
fome  further  conjectures  might  be  offered  concerning 
its  remote  cauies  ;  but  none  of  them  appear  to  me  ve- 
ry fatisfying  ;  and  whatever  they  might  be,  it  appears 
to  me  they  muft  again  be  refolved  into  the  fuppolition 
of  a  general  laxity  and  debility  of  the  fyfttm. 
MDCCXXIX. 

It  is  upon  this  fuppolition  ahnoft  alone  that  the 
cure  of  rickets  has  entirely  proceeded.  The  remedies 
have  been  fuch  efpccially  as  were  fuited  to  improve 
the  tone  of  the  fyltem  in  general,  or  of  the  ftomach  in 
particular  :  and  we  know  that  the  latter  are  not  only 
fuited  to  improve  the  tone  of  the  ftomach  itfelf,  but 
by  that  means  to  improve  aiib  the  tone  of  the  whole 
fyiiem. 

MDCCXXX. 

Of  tonic  remedies^  one  of  the  nio(t  promiiuVg  feems 
to  have  been  cold  bathing  ;  and  I  have  found  it  the 
moil  powerful  in  preventing  the  difeafe,  For  a  long 
time  pad,  it  has  been  the  practice  in  this  country, 
with  people  of  all  ranks,  to  wa/h,  their  children  from 
the  time  of  their  birth  with  cold  wales  >;  and  from 
the  time  that  children  are  ti  month  old,  ut-has  been 
the  practice  with  people  of  better  rank  to  have  "hem 
Z  z  2  cii]»}x-d 


364  PRACTICE 

clipped  entirely  in  cold  water  every  morning  :  and 
wherever  this  pra&ice  has  been  purfued,  I  have  not 
met  with  any  inftance  of  rickets.  Amongft  our  com- 
mon people,  although  they  warn  their  children  with 
cold  water  only,  yet  they  do  not  f0  commonly  pra&ife 
immerfion :  and  when  amongft  thefe  I  meet  with  in- 
flances  of  rickets,  I  prefcribe  cold  bathing ;  which  ac- 
cordingly has  often  checked  the  progrefs  of  the  dif- 
eafe,  and  fometimes  feems  to  have  cured  it  entirely. 
MDCCXXXL 

The  remedy  of  Ens  Veneris^  recommended  by  Mr. 
Boyle,  and  fince  his  time  very  univerfally  employed, 
is  to  be  coniidered  as  entirely  a  tonic  remedy.  That 
or  fome  other  preparation  of  iron  I  have  almofl  con- 
flantly  employed,  though  not  indeed  always  with 
fuccefs.  I  have  been  perfuaded,  that  the  ens  veneris, 
of  Mr.  Boyle,  notwithstanding  his  giving  it  this  appel- 
lation, was  truly  a  preparation  of  iron,  and  no  other 
than  what  we  now  name  the  Flores  Martiales*  :  but 
it  appears,  that  both  Benevoli  and  Buchner  have  em- 
ployed a  preparation  of  copper;  and  I  am  ready  ta 
believe  it  to  be  a  more  powerful  tonic  than  the  prepa- 
rations of  iron  $. 

MDCCXXXIL 

Upon  the  fuppofttion  of  tonic  remedies  being  pro- 
per 

*  The  dofe  of  this  medicine  is  from  four  to  twenty  grains,  it 
mufl  be  o;iven  in  the  form  of  a  bolus.  The  young  pra&itioner 
ou<*ht  to  beware  of  prefcribing  fiores  martiales  in  pills,  which  will 
fweli  and  crumble  to  pieces  if  they  are  not  compofed  of  a  confider- 
able  quantity  of  f-.'i -  c  s^ummi  refin. 

The  Flores  r  ales,  may  be  very  conveniently  given  in  a  tinfture 
of  proof  fpirit.  There  is  a  formula  of  it  in  the  laft  London  Phar- 
macopoeia, under  the  nam<;-  of  Tiuclura  ferri  Ammoniacalis.  1'he 
dofe  of  it  is  a  tea-fpoonful  in  a  wine  glafs  of  cold  wa.ter,  and  it  is  a 
veiy  c/^.^ant  form  of  adminifteririg  chalybeates. 

§  Copp£-  is  a  very  dangerous  remedy,  as  was  mentioned  above  in 
the  n  •'  -,s  on  article  1336.      The  Author  had  a  very  high  opinion  .  : 
-r  as  a  tonic- 


OF     PHYSIC.  365 

per  in  this  difeafe,  I  have  endeavoured  to  employ  the 
Peruvian  bark  :  but  Jrom  the  difficulty  of  adminifter- 
ing  it  to  infants  in  any  ufeful  quantity,  I  have  not 
been  able  to  difcover  its  efficacy ;  bur  I  arn  very  ready 
to  believe  the  teftimony  of  Be  Haen  upon  this  fub- 
jedt*. 

MDCCXXXIIL  ' 

Exercife,  which  is  one  of  the  moft  powerful  tonics, 
has  been  properly  recommended  for  the  cure  of  rick- 
ets ;  and  as  the  exerciie  of  geitation  only  can.  be  em- 
ployed, it  ihouid  always  be,  with  the  child  laid  in  a 
horizontal  lituation  ;  as  the  carrying  them  or  moving 
them  in  any  degree  of  an  erect  poflure,  is  very  apt  to 
occafion  fome  diftortion.  It  is  extremely  probable, 
that,  in  this  difeafe,  friction  with  dry  flannels  may  be 
found  an  ufeful  remedy. 

MDCCXXXIV. 

It  is  alfo  fufficiently  probable,  that  the  avoiding  of 
moiittire  is  not  only  advifable,  but  may  likswife  be  cf 
fervice  in  the  cure  of  this  difeafe. 

There  is  no  doubt  that  a  certain  diet  may  contribute 
to  the  fame  end  ;  but  what  may  be  the  moft  eligible, 
I  dare  not  determine.  I  have  no  doubt  that  leaven- 
ed bread  may  be  more  proper  than  unfermented  fari- 
nacea  ;  but  I  cannot  find  any  reafon  to  believe  that 
firong  beer  can  even  be  a  proper  remedy. 

Pradli- 

*  It  is  daubtlefs  difficult  to  make  children  f wallow  a  fufEcient  quan- 
tity of  bark  to  produce  any  good  effects,  yet  it    is  not  impoflible, 
The  formula  befc  adapted  for  children,  is  the  powder  of  the  extract  ; 
but  as  it  fometimes  occafions  conilipation,  this  effed  muft  be  guarded 
agairitt  by  fome  proper  laxatives,  eipecially  by  Rhubarb  given  either 
with  the  bark  or  feparately.     The  following  formula  is  a  proper  dofe 
for  a  child  of  two  years  old,  to  be  repeated  twice  a-clay  ; 
I>.  Extr.  Cort.  PCTUV.  dur.  gr.  viii. 
Pulv.  Had.  Rhei.  gr.  x. 
Sacch.  alb.  <*r.  xv. 
M.  f.  pulv.  " 


366  P  R  A  C  T  I  C  E 

Practitioners  have  been  divided  in  opinion  concern* 
ing  the  ufe  of  milk  in  this  difeafe.  Zeviani,  perhaps 
from  theory,  condemns  the  ufe  of  it ;  but  Benevoli 
employed  it  without  its  impeding  the  cure  of  the  dif- 
eafe. This  laft  I  have  often  remarked  in  the  courfe  of 
my  own  practice.  As  it  is  difficult  to  feed  children 
entirely  without  milk ;  fo  I  have  commonly  admitted 
it  as  apart  of  the  diet  of  rickety  children  ;  and  in  ma- 
ny inftances  I  can  affirm,  that  it  did  not  prevent  the 
cure  of  the  difeafe.  In  cafes,  however,  of  any  appear- 
ance of  rickets,  and  particularly  of  a  flow  dentition,  I 
have  difTuaded  the  continuance  of  a  child  upon  the 
bread  ;  becaufe  the  milk  of  women  is  a  more  watery 
-nounfhrnent  than  that  of  cows  :  and  I  have  efpecially 
diffuaded  the  continuing  a  child  upon  the  breaft, 
when  I  thought  the  nurfe  gave  rather  too  much  of 
fuch  a  watery  nourishment ;  for,  as  has  been  above 
mentioned,  I  have  had  frequent  occalion  to  fuipect, 
that  the  milk  of  fuch  nurfes-has  a  tendency  to  fa.vour 
the  coming  on  of  rickets*. 

MDGCXXXV. 

Befides  the  remedies  and  regimen  now  mentioned, 
practitioners  have  commonly  employed  in  this  difeafe, 
both  emetics  and  purgatives.  When  the  appetite  and 
digeition  are  confiderably  impaired,  vomiting,  if  nei- 
ther violent  nor  frequently  repeated,  feems  to  be  of 
fervice ;  and,  by  a  moderate  agitation  of  the  abdomi- 
nal vifcera,  may  in.fome  meafure  obviate  the  ftagna- 
tion  and  confequent  fwelling  that  ufually  occur  in 
them. 

As  the  tumid  flate  of  the  abdomen,  fo  constantly  to 
be  met  with  in  this  difeafe,  feems  to  depend  very  much 
upon  a  tympanitic  afFeclion  of  the  interlines ;  fo,  both 
by  obviating  this,  and  by  deriving  from  the  abdomi- 
nal vifcera,  frequent  gentle  purgatives  may  be  of  fer- 
vice • 

*  How  does  this  accord  with  the  laft  fentence  of  article  i  722. 


O  F    P  H  Y  S  I  C.  367 

tree.     Zeviani,  perhaps  properly,  recommends  in  par- 
ticular rhubarb  ;  which,  betides  its  purgative  quality, 
has  thofe  alfo  of  bitter  and  aftringent. 
MDCCXXXVI. 

I  have  now  mentioned  moil  of  the  remedies  com- 
monly employed  by  the  practitioners  of  former  times ; 
but  I  mii-ft  not  omit  mentioning  fome  others  that  have 
been  lately  fuggefted.  The  late  Mr.  De  Haen  re- 
commends the  teftacea ;  and  afTures  of  their  having 
been  employed  with  fuccefs ;  but  in  the  few  trials 
which  I  have  had  occafion  to  make,  their  good  effects 
did  not  appear. 

The  late  Baron  Van  Swieten  gives  us  one  inftance 
of  rickets  cured  by  the  life  of  hemlock ;  but  I  do  not 
know  that  the  practice  has  been  repeated. 


BOOK         III. 


OF       THE 


I    M    P    E    T    I    G    I    N    I    S; 


O    R 


DEPRAVED  HABIT,    WITH    AFFECTIONS  OF 
THE    SKIN. 

MDCCXXXVIL 

1FIND  it  difficult  to  give  any  fufficiently  correct 
and  proper  character  of  this  order.     The  difeafes 
comprehended  under  it,  depend,  for  the  mod  part,  up- 
on a  depraved  flare  of  the  whole  of  the  fluids,  produc- 


ng 


363  PRACTICE 

ing  tumours,  eruptions,  or  other  preternatural  ai- 
tions  of  the  (kin.  Although  it  be  extremely  difficult 
to  find  a  general  character  of  the  order  that  will  ap- 
ply to  each  of  the  genera  and  fpecies,  I  ihall  here  treat 
of  the  principal  genera  which  have  been  commonly 
comprehended  under  this  order,  and  which  1  have 
enumerated  in  my  Nofology. 


CHAP.      I. 

OF  SCROPHULA,    OR  THE   KING's  EVIL: 

MDCCXXXVilL 

THE  character  of  this  difeafe  I  have  attempted  in 
my  Nofology  :  but  it   will   be   more   properly 
taken  from  the  whole  of  its  hiftory,  now  to  be  deliver- 
ed. 

MDCCXXXIX. 

It  is  commonly,  and  very  generally,  a  hereditary 
difeafe ;  and  although  it  fometimes  may,  yet  it  rarely 
appears,  but  in  children  whofe  parents  had  at  fome 
period  of  their  lives  been  affected  with  it.  Whether 
it  may  not  fail  to  appear  in  the  children  of  fcrophu- 
lous  parents,  and  difcover  itfelf  afterwards  in  their 
offspring  in  the  iucceeding  generation,  I  cannot  cer- 
tainly determine;  but  believe  that  this  has  frequently 
happened.  It  appears  to  me  to  be  derived  more  com- 
monly from  fathers  than  from  mothers;  but  whether 
this  happens  from  there  being  more  fcrophulous  men 
than  fcrophulous  women  married,  I  am  not  certain. 

With  refpect  to  the  influence  of  parents  in  produc- 
ing this  difeafe,  ir  cleferves  to  be  remarked,  that  in  a. 
family  of  many  children,  \vhta  one  of  the  parents  has 

•    been 


O  F       P  H  Y  S  I  C.  369, 

been  aiTe&ed  with  fcrop-hula,  and  the  other  not; 
as  it  is  ufual  for  fome  of  the  children  to  be  in  con- 
ilitution  pretty  exactly  like  the  one  parent,  and  others 
of  them  like  the  other;  it  commonly  happens,  that 
thofe  children  who  moft  refemble  the  fcrophulous  pa- 
rent become  affeded  with  fcrophula,  while  thofe  re- 
fembling  the  other  parent  entirely  efcape. 
MDCCXL. 

The  fcrophula  generally  appears  at  a  particular  pe- 
riod of  life.  It  feldom  appears  in  the  firit,  or  even  in 
the  fecond  year  of  a  child's  life  ;  and  moil  commonly 
it  occurs  from  the  fecond,  or,  as  fome  alledge,  and  per- 
haps more  properly,  from  the  third,  to  the  feventh 
year..  Frequently,  however,  it  difcovers  itfelf  at  a 
later  period  ;  and  there  are  inflances  of  its  firft  appear- 
ance, at  every  period  till  the  age  of  puberty ;  after 
which,  however,  the  firft  appearance  of  it  is  very 
tare. 

MDCCXLI. 

When  it  does  not  occur  very  early  ,|we  can  general- 
ly diftinguifh  the  habit  of  body  peculiarly  difpofed  to 
it.  It  moft  commonly  affecls  children  of  foft  and 
flaccid  habits,  of  fair  hair  and  blue  eyes  ;  or  at  leaft 
affeds  thofe  much  more  frequently  than  thofe  of  an 
oppoiite  Complexion.  It  afFecls  efpecially  children  of 
fmooth  ikins  and  rofy  cheeks ;  and  fuch  children  have 
frequently  a  tumid  upper  lip,  with  a  chop  in  the  mid- 
dle of  it;  and  this  tumour  is  often  conliderable,  and 
extended  to  the  columna  nali  and  lower  part  of  the 
noflrils*  The  difeafe  is  fometimes  joined  with,  or 
follows  rickets  ;  and  although  it  frequently  appears  in 
children  who  have  not  had  rickets  in  any  great  degree^ 
yet  it  often  attacks  thofe  who,  by  a  protuberant  forer 
head,  by  tu.*nid  joints,  and  a  tumid  abdomen,  fliow 
that  they  had  fome  rachitic  difpofition.  In  parents 
who,  without  having  had  the  difeafe  themfelves,  feeni 
to  produce  fcrophulous  children,  we  can  commonly 

VOL.  II.  3  A  per- 


370  PRACTICE 

perceive  much  of  the  fame  habit  and  conftitution  that 
has  been  juft  now  defcribed. 

Some  authors  have  fuppofed  that  the  fmall-pox  has 
a  tendency  to  produce  this  difeafe  ;  and  Mr.  De  Haen 
ailerts  its  following  the  inoculated,   more  frequently 
than  the  natural  fmall-pox.     This  lad  pofition,   how- 
ever, we  can  confidently  affirm  to  be  a  miftake;  al- 
though it  mufl  be  allowed,   that  in  fact  the  fcrophula 
does  often  come  on  immediately  after  the  fmall-pox. 
It  is,  however,  difficult  to  find  any  connection  between 
the  two  difeales.     According  to  my  obfervation,    the 
accident   only   happens  in  children  who  have  pretty 
manifeftly  the  fcrophulous  difpofition  ;  and  I  have  had 
feveral  inftances  of  the  natural  fmall-pox  coming  up- 
on children  affected  at  the  fame  time  with  fcrophula, 
not  only  without  this  difeafe  being  any  ways  aggravat-  . 
ed  by  the  fmall-pox,   but  even  of  its  being  for  fome 
time  after  much  relieved. 

MDCCXLH. 

The  fcrophula  generally  {hows  itfelf  firfl  at  a  par- 
ticular feafon  of  the  year ;  and  at  fome  time  between 
the  winter  and  fummer  folftice  ;  but  commonly  long 
before  the  latter  period.  It  is  to  be  obferved  further, 
that  the  courfe  of  the  difeafe  is  ufually  connected  with> 
the  courfe  of  thp  feafons.  Whilfl  the  tumours  and 
ulcerations  peculiar  to  this  difeafe,  appear  firfl  in  the 
fpring,  the  ulcers  are  frequently  healed  up  in  the 
courfe  of  the  fucceeding  fummer,  and  do  not  break  out 
again  till  the  enfuing  fpring,  to  follow  again  with  the 
feafon  the  fame  courfe  as  before. 

MDCCXUII. 

Frequently  the  firft  appearance  of  the  difeafe  is  the 
tumid  and  chopped  lip  above  mentioned.  .Upon  other 
occafions,  the  firft  appearance  is  that  of  ftnall  fpheri- 
cal  or  oval  tumours,  moveable  under  the  fkin.  They 
are  foft>  but  with  fome  elafticity.  They  are  without 
pain;  and  without  any  change  in  the  colour  .of  the 


OF    PHYSIC  371 

ikin;  In  this  ftate  they  often  continue  for  a  long 
time ;  even  for  a  year  or  two,  and  fumetimes  longer. 
Mofl  commonly  they  firft  appear  upon  the  fides  of 
the  neck  below  the  ears ;  but  fometimes  alfo  under 
the  chin.  In  either  cafe,  they  are  luppofed  to  affecl: 
in  thefe  places  the  conglobate  or  lymphatic  glands 
only  :  and  not  at  all  the  faltvary  glands,  till  the  dif- 
eafe  is  very  greatly  advanced.  The  difeafe  frequently 
affects,  and  even  at  firit  appears  in,  other  parts  of  the 
body.  In  particular,  it  affeds  .the  joints  of  the  elbows 
and  ankles,  or  thofe  of  the  fingers  and  toes.  The  ap- 
pearances about  the  joints  are  not  commonly,  as  elfe- 
where,  fmall  moveable  fwellings ;  but  a  tumour  almofl 
uniformly  furrounding  the  joint,  and  interrupting  its 
motion. 

MDCCXLIV. 

Thefe  tumours,  as  I  have  laid,  remain  for  fome  time 
little  changed  ;  and,  from  the  time  they  firft  appear 
in  the  fpring,  they  often  continue  in  this  way  till  the 
return  of  the  fame  feafon  in  the  next,  or  perhaps  the 
fecond  year  after.  About  that  time,  however,  or  per- 
haps in  the  courfe  of  the  feafon  in  which  they  firft  ap- 
pear, the  tumour  becomes  larger  and  more  fixed  ;  the 
ikinupon  it  requires  a  purple,  feldom  a  clear  rednefs  : 
but  growing  redder  by  degrees,  the  tumour  becomes 
fofter,  and.  allows  the  fluctuation  of  a  liquid  within  to. 
be  perceived.  All  this  procefs,  however,  takes  place 
with  very  little  pain  attending  it.  At  length  fome 
part  of  the  (kin  becomes  paler  ;  and  by  one  or  more 
fmall  apertures  a  liquid  is  poured  out. 
MDCCXLV. 

The  matter  poured  out  has  at  firft  the  appearance  of 
pus,  but  it  is  ufually  of  a  thinner  kind  than  that  from 
phlegmon ic  ahfcelfes  ;  and  the  matter  as  it  continues 
to  be  difcharged,  becomes  daily  lefs  purulent,  and  ap- 
pears more  and  more  a  vifcid  ferum,  intermixed  with 
fmail  pieces  of  a  white  fubftance  refembling  the  curd 
of  milk.  By  degrees  the  tumour  almoft  entirely  fub- 

3  A  2  fides 


37-2  PRACTICE 

fides  while  the  ulcer  opens  more,  and  fpreads  broad- 
er :  unequally,  however,  in  different  directions,  and 
therefore  is  without  any  regular  circumfcription. — 
The  edges  of  the  ulcer  are  commonly  flat  and  fniooth, 
both  on  their  outride  and  their  inner  edge,  which  fel- 
dom  puts  on  a  callous  appearance.  The  ulcers,  how- 
ever, do  not  generally  fpread  much,  or  become  deep- 
er ;  but  at  the  time  their  edges  do  not  advance,  or  put 
on  any  appearance  of  forming  a  cicatrix. 
MDCCXLVL 

In  this  condition  the  ulcers  often  continue  for  a 
long  time ;  while  new  tumours,  with  ulcers  fucceed- 
ing  them  in  the  manner  above  defcribed,  make  their 
appearance  in  different  parts  of  the  body.  Of  the 
firit  ulcers,  however,  forne  heal  up,  while  other  tu- 
mours and  ulcers  appear  in  their  vicinity,  or  in  other 
parts  of  the  body  ;  and  in  this  manner  the  difeafe 
proceeds,  fome  of  the  ulcers  healing  up,  at  lead  to  a 
certain  degree,  in  the  courfe  of  fumfner,  and  breaking 
out  again  in  the  fucceeding  fpring  ;  or  it  continues, 
by  new  tumours  and  ulcers  fucceeding  them,  in  che 
fpring  feafon,  making  their  appearance  (ucceffively  for 
feveral  years. 

MDCCXLVIL 

In  this  way  the  difeafe  goes  on  for  feveral  years  :, 
but  very  commonly  in  four  or  five  years  it  is  fpontane- 
oufly  cured,  the  former  ulcers  being  healed  up,  and 
no  new  tumours  appearing  ;  and  thus  at  length  the 
difeafe  ceafes  entirely,  leaving  only  fome  indelible 
efchars,  pale  andfmooth,  but  in  fome  parts  fhrivelled; 
or,  where  it  had  occupied  the  joints,  leaving  the  mo- 
tion of  thefe  impaired,  or  entirely  defiroyed. 
MDCCXLVIII. 

Such  js  the  moil  favourable  courfe  of  this  difeafe  ; 
and  with  us,  it  is  more  frequently  fuch,  than  other- 
wife  :  but  it  is  often  a  more  violent,  and  fomctimes  a 
fatal  malady-  In  thefe  cafes,  more  parts  of  the  body 

are 


OF    PHYSIC.  373 

are  at  the  fame  time  affe&ed  ;  the  ulcers  alfo  feeming 
to  be  imbued  with  a  peculiar  fharp  acrimony,  and 
therefore  becoming  more  deep,  eroding,  fpreading,  as 
well  as  feldomer  healing  up.  In  fuch  cafes,  the  eyes 
are  often  particularly  affected.  The  edges  of  the  eye- 
lids are  affected  with  tumour,  and  furxerficial  ulcera- 
tions ;  and  thefe  commonly  excite  obiunate  inflamma- 
tion in  the  adnata,  which  frequently  produces  an  opa^ 
city  of  the  cornea. 

When  the  fcrophula  efpecially  affects  the  joints,  it 
fometimes  produces  there  confiderable  tumours  ;  in 
the  abfceffes  following  which,  the  ligaments  and  car- 
tilages are  eroded,  and  the  adjoining  bones  are  affect- 
ed with  a  caries  of  a  peculiar  kind.  In  thefe  cafesa 
alfo,  of  more  violent  fcrophula,  while  every  year  pro- 
duces a  number  of  new  tumours  and  ulcers,  their  acri- 
mony feems  at  length  to  taint  the  whole  fluids  of  the 
body,  occaiioning  various  diforders ;  and  particularly 
a  hectic  fever,  with  all  its  fymptoms,  which  at  length 
proves  fatal,  with  fometimes  the  fymptoms  of  plnhifis-, 
pulmonalis. 

MDCCXLIX. 

The  bodies  of  perfons  who  have  died  of  this  difeafe 
ftiow  many  of  the  vifcera  in  a  very  morbid  ffote  ;  and 
particularly  moil  of  the  glands  of  the  mer-icntcry 
very  much  tumefied,  and  frequently  in  an  ulcerated 
{late.  Commonly  alfo  a  great  number  of  tubercles 
or  cyfis,  containing  matter  of  various  kinds,  appear  in 
the  lungs. 

MDCCL, 

Such  is  the  hifiory  of  the  difeafe  ;  and  from  thence 
it  may  appear,  that  the  nature  of  it  is  not  eafily  to  be 
afcertained.  It  feems  to  be  a  peculiar  affection  of  the 
lymphatic  fyftcm  ;  and  this  in  fome  meafure  accounts 
for  its  connection  with  a  particular  period  of  life. 
Probably,  however,  there  is  a  peculiar  acrimony  of  the 
fluids  that  is  in  the  proximate  caufe  of  the  difeafe  ;  al~ 

though 


PRACTICE 

though  of  what  nature  this  is,  has  not  yet  been  difco.^ 
vered.  It  may  perhaps  be  generally  diffufed  in  the 
fyftein,  and  exhaled  into  the  feverai  cavities  and  cellu^ 
lar  texture  of  the  body  :  and  therefore,  being  taken 
up  by  the  abforbents,  may  difcover  itfelf  efpecially  in 
the  lymphatic  fyftem,  .This,  however,  will  hardly 
account  for  its  being  more  confined  to  that  fyftem, 
than  happens  in  the  cafe  of  many  other  acrimonies 
which  may  be  fuppofed  to  be  as  generally  diffufed. — 
In  mort5  its  appearance  in  particular  conftitutions,  and 
at  a  particular  period  of  life,  and  even  its  being  a 
hereditary  difeafe,  which  fo  frequently  depends  upon 
the  tranfmiilion  of  a  peculiar  conflitution,  are  all  of 
them  circumftances  which  lead  me  to  conclude,  upon 
the  whole,  that  this  difeafe  depends  upon  a  peculiar 
conjliiution  of  the  lymphatic  fyftem. 
MDCGLI. 

It  feems  proper  to  obferve  here,  that  the  fcrophula- 
does  not  appear  to  be  a  contagious  difeafe;  at  lead  I 
have  known  many  inftances  of  found  children  having 
had  frequent  and  clofe  intercourle  with  fcrophulous 
children  without  being  infected  with  the  difeafe.  This 
certainly  ihows,  that  in  this  difeafe  the  peculiar  acri- 
mony of  it  is  not  exhaled  from  the  furface  of  the  body^ 
but  that  it  depends  efpecially  upon  a  peculiar  cpnili- 
tution  of  the  fyftem. 

MDCCLII. 

Several  authors  have  fuppofed  the  fcrophula  to  have 
been  derived  from  the  venereal  difeafe  ;  but  upon  no 
jull  grounds  that  I  can  perceive.  In  very  many  in- 
itances,  there  can  hardly  be  any  fufpicion  of  the  pa- 
rents producing  this  difeafe  having-  been  imbued  with 
iiphylis  to  their  offspring,  in  whom,  however,  no  fcro- 
phulous fymptoms  at  any  time  afterwards  appeared. 
Further,  the  fymptoms  of  the  two  difeafes  are  very  dif- 
ferent ;  and  the  difference  of  their  natures  appear  par- 
ticularly from  hence,  that  while  mercury  commonly 

end 


O  F    P  H  Y  S  I  C,  375 

and  readily  cures  the  fiphylis,  it  does  no  fervice  in 
fcrophula,  and  very  often  rather  aggravates  the  dif- 
eafe. 

MDCCLIII. 

For  the  cure  of  fcrophula,  we  have  not  yet  learned 
any  pradice  that  is  certainly  or  even  generally  fuccefs- 
ful. 

The  remedy  which  feems  to  be  the  moft  fuccefsful, 
and  which  our  praditioners  efpecially  truft  to  and 
employ,  is  the  ufe  of  mineral  waters ;  and  indeed  the 
wafhing  out,  by  means  of  thefe,  the  lymphatic  fyftem, 
would  feem  to  be  a  meafure  promifing  fuccefs :  but  iri 
Very  many  inftances  of  the  ufe  of  theie  waters,  I  have 
not  been  well  fatistied  that  they  had  fhortened  the  dd- 
ration  of  the  difeafe  more  than  had  often  happened 
when  no  fuch  remedy  had  been  employed. 

MDCCL1V. 

With  regard  to  the  choice  of  the  mineral  waters 
moil  fit  for  the  purpofe,  I  cannot  with  any  confidence 
give  an  opinion. 

A 1  moft  all  kinds  of  mineral  waters,  whether  chaly- 
beate, fuiphureous,  or  faline,  have  been  employed  for 
the  cure  of  fcrophula,  and  feemingly  with  equal  fuc- 
cefs and  reputation  :  a  circumftance  which  leads  me  to 
think,  that,  if  they  are  ever  fuccefsful,  it  is  the  ele- 
mentary water  that  is  the  chief  part  of  the  remedy. 

Of  late,  fea- water  has  been  efpecially  recommend- 
ed and  employed ;  but  after  numerous  trials,  I  cannot 
yet  difcover  its  fuperior  efficacy. 
MDCCLV 

The  other  remedies  propofed  by  pradical  writers 
are  very  numerous ;  but,  Hpon  that  very  account,  I 
apprehend  they  are  little  to  be  trufted  :  and  as  I  can- 
not perceive  any  juft  reafon  for  expeding  fuccefs  from 
them,  I  have  very  feldom  employed  them. 

Of  late,  the  Peruvian  bark  has  bt-esi  much  recom- 
mended :  and  as  in  fcrophulous  perfons  there  are  ge- 
nerally 


376  PRACTICE 

herally  fome  marks  of  laxity  and  flapcidity,  this  tonic 
may  pouToly  be  of  fervice ;  but  in  a  great  variety  of 
trials,  I  have  never  fecnit  produce  any  immediate  cure 
of  the  difeafe. 

In  feverai  inftances,  the  leaves  of  colts-foot  have 
appeared  to  me  to  be  fuccefsfui.  I  have  ufed  it  fre- 
quently in  a  ftron-g  decoction,  and  even  then  with  ad- 
vantage :  but  have  found  more  benefit  from  the  ex- 
preiTed  juice,  when  the  plant  r.ould  be  had  in  fomewhat 
of  afucculent  ftate,  foon  after  its  firft  appearance  in  the 
fpring.  MDCCLVI. 

I  have  aifo  frequently  employed  the  hemlock,  and 
have  fometimes  found  it  uieful  in  difcufling  obfiinate 
fwellings  :  but  in  this,  it  has  alfo  often  difappointed 
me  :  and  I  have  not  at  any  time  obferved  that  it  dif- 
pofed  fcrophulous  ulcers  to  heal. 

I  cannot  conclude  the  fubjedt  of  internal  medicines 
without  remarking,  that  I  have  never  found  either 
mercury  or  antimony,  in  any  iliape,  of  ufe  in  this  dif- 
eafe; and  when  any  degree  of  a  fevcriih  ftate  had 
come  on,  the  ufe  of  mercury  proved  manifeftly  hurtful. 

MDCCLVII- 

In  the  progrefs  of  fcrophula,  feveral  external  medi- 
cines are  requifite.  Several  applications  have  been 
vtfed  for  difcuffing  the  tumours  upon  their  firft  com- 
ing on ;  but  hitherto  my  own  practice,  in  thefe  re- 
fpects,  has  been  attended  with  very  little  fuccefs. — 
The  folution  of  the  faccharum  faturni  has  feemed  to 
be  ufeful ;  but  it  has  more  frequently  failed  :  And  I 
have  had  no  better  fuccefs  with  the  fpiritus  Mindereri. 
Fomentations  of  every  kind  have  been  frequently 
found  to  do  harm ;  and  poultices  feem  only  to  hurry 
on  a  fuppuration.  I  am  doubtful  if  this  lafl  be  ever 
praclifed  with  advantage ;  for  fcrophulous  tumours 
fometimes  fpontaneouily  dilappear,  but  never  after  a-* 
ny  degree  of  inflammation  has  come  upon  them  ;  and 
therefore  poultices,  which  commonly  induce  in- 
flammation 


OF    PHYSIC,  377 

flammation,  prevent  that  difcuffion  of  tumours,  which 
might  other  wife  have  happened. 

Even  when  fcrophulous  tumours  have  advanced  to- 
wards fuppuration,  I  am  unwilling  to  haften  the  fpon- 
taneoiis  opening,  or  to  make  it  by  the  lancet ;  becaufe 
I  apprehend  the  fcrophulous  matter  is  liable  to  be  ren- 
dered more  acrid  by  cdmmunicanon  with  the  air,  and 
to  become  more  eroding  and  ipreadihg  than  when  irt 
its  inclofed  ftate. 

MDCCLVill. 

The  management  of  fcrophulous  ulcers  has,  fo  far 
as  I  know,  been  as  little  fuccefsful  as  that  of  the  tu- 
mours. Efcharotic  preparations,  of  either  mercury  or 
copper  have  been  fometimes  ufeful  in  bringing  on  a 
proper  fuppuration,  and  thereby  difpofing  the  ulcer  to 
heal ;  but  they  have  feldom  fucceeded,  and  more  com- 
monly they  have  caufed  the  ulcer  to  fpread  more.  Trie 
efcrurotic  from  which  I  have  received  mofl  benefit 
is  burnt  alum,  and  a  portion  of  that  mixed  with  a 
mild  ointment,  has  been  as  ufeful  an  application  as  a- 
ny  I  have  tried.  The  application,  however,  that  I 
have  found  mofl  ferviceable  and  very  ufiivefially  ad- 
miilible,  is  that  of  linen  cloths  wetted  with  cold  water, 
and  frequently  changed  when  they  are  becoming  dry, 
it  being  inconvenient  to  let  them  be  glued  to  the  fore. 
They  are  therefore  to  be  changed  frequently  during 
the  day  ;  and  a  cloth  fpread  with  a  mild  ointment  or 
plaifter  may  be  applied  for  the  night.  In  this  prac- 
tice I  have  fometimes  employed  fea-water;  but  gene- 
rally it  proved  too  irritating;  and  neither  that  nor  any 
mineral  water  has  appeared  to  be  of  more  fervice  than 
common  Water. 

MDCCLIX. 

To  conclude  what  I  have  to  offer  upon  the  cure  of 
ferophula,  I  mufl  obferve,  that  cold  bathing  feems  to 
have  been  of  more  benefit  than  any  other  remedy 
that  I  have  had  occafion  to  fee  employed. 

VOL.  II.  3  B  C  II  A  P. 


373  PRACTICE 

CHAP.        II. 
OF  S1PHILIS,  OR  THE  VENEREAL  DISEASE, 

MDCCLX. 

AFTER  practitioners  hare  had  fo  much  experi- 
ence in  treating  this  difeafe,  and  after  fo  many 
books  have  been  publimed  upon  the  fubjecl,  it  does 
not  feem  neceflary,  or  even  proper,  for  me  to  attempt 
any  full  treatife  concerning  it;  and  I  (hall  therefore 
confine  myfelf  to  fuch  general  remarks,  as  may  ferve 
to  illuftrate  fome  parts  of  the  pathology  or  of  the 
practice. 

MDCCLXI. 

It  is  fufficiently  probable,  that,  anciently,  in  certain 
parts  of  Alia,  where  the  leprofy  prevailed,  and  in  Eu- 
rope after  that  difeafe  had  been  introduced  into  it,  a 
difeafe  of  the  genitals,  refembling  that  which  now 
commonly  arifes  from  fiphylis,  had  frequently  appear- 
ed :  but  it  is  equally  probable,  that  a  new  difeafe,  and 
what  we  at  prefent  term  Sipbytis^  was  firfi  brought  in- 
to Europe  about  the  end  of  the  fifteenth  century  ;  and 
that  the  diftemper  now  fo  frequently  occurring,  has 
been  very  entirely  derived  from  that  which  was  im- 
ported from  America  at  the  period  mentioned*. 

MDCCLXII. 

*  Various  opinions  have  been  held  by  different  phyficians  about 
the  origin  of  this  difeafe  ;  fome  fuppofmg  it  to  have  exilted  in  the 
old  world,  while  others  think  it  was  imported  from  the  new  world, 
clifcovered  by  Columbus.  The  difpute  produced  many  controverfial  ^ 
tra<fls,  from  the  perufal  of  which,  the  young  practitioner  can  gain 
Jittle  advantageous  knowledge.  All  that  we  certainly  know  about 
th?  origin  of  the  difeafe  is,  that  it  was  firft  obferved  among  the  French  ? 
when  they  were  at  Naples  in  the  year  1493,  and  that  it  was  brought 
into  France  by  the  French  who  returned  thither  with  Charles.  Co- 
lumbus landed  at  Palos  on  the  I5th  of  March  in  the  fame  year,  on 
his  return  from  his  firft  voyage.  The  difeafe  therefore,  if  imported 
by  Columbia's  crew  muft  have  fpread  rapidly  through  Europe. 


OF    PHYSIC.  379 

MDCCLXII. 

This  difeafe,  at  leaft  in  its  principal  circumftances, 
never  arifes  in  any  perfon  but  from  feme  communi- 
cation with  a  perfon  already  affected  with  it.  It  is 
mod  commonly  contracted  in  confequence  of  coition 
with  an  infected  perfon  ;  but  in  what  manner  the  in- 
fection is  communicated,  is  not  clearly  explained.  I 
am  perfuaded,  that  in  coition,  it  is  communicated 
without  there  being  any  open  ulcer  either  in  the  per- 
fon receiving  the  infection  j  but  in  all  other  cafes,  I 
believe  it  is  never  communicated  in  any  other  way 
than  by  a  contact  of  ulcer,  either  in  the  perfon  com- 
municating, or  in  the  perfon  receiving  the  infection. 
MDCCLXIII. 

As  it  thus  arifes  from  the  contact  of  particular  parts, 
fo  it  always  appears  firft  in  the  neighbourhood  of  the 
parts  to  which  the  infecting  matter  had  been  immedi- 
diateiy  applied  ;  and  therefore,  as  mod  commonly 
contracted  by  coition,  it  generally  appears  firft  in  the 
genitals. 

MDCCLXIV. 

After  its  firft  appearance  in  particular  parts,  more 
efpecially  when  thefc  are  the  genitals  of  either  fex,  its 
effects  for  fome  time  feem  to  be  confined  to  chefe 
parts;  and  indeed,  in  many  cafes,  never  extends  fur- 
ther. In  other  cafes,  however,  the  infecting  matter 
paiTes  from  the  parts  firft  affected,  and  from  the  geni- 
tal, therefqre,  into  the  blood-veil^ls  ;  and  being  there 
dirnifed,  produces  diforders  in.  many  other  parts  of 
the  body. 

From  this  view  of  the  circumilances,  phyficians 
have  very  properly  diftingtiifhed  the  different  (tares  of 
the  difeaie,  according  as  they  are  local  or  are  more 
imiverfal.  To  the  former,  they  have  adapted  appella- 
tions fuited  to  the  manner  in  which  the  difeaie  ap- 
pears ;•  and  to  the  other  the  general  affection,  they 
have  almofl  totally  confined  the  appellations  of  Sipbv- 

3  B  2  //>, 


380  PRACTICE 

Us,  Lues  Venerea^  or  Pox.  In  the  remarks  I  am  now 
to  offer,  I  fhall  begin  with  confidering  the  local  affec- 
tion. 

MDCCLXV. 

This  local  affection  appears  chiefly  in_  the  form  of 
gonorrhoea  or  chancre. 

The  phenomena  or  gonorrhoea,  either  upon  its  firft 
coming  on  or  in  its  after  progrefs,  or  the  fymptoms  of 
ardor  urinae,  chordee,  or  others  attending  it,  it  is  not 
neceffary  for  me  to  defcribe.  I  fhall  only  here  obferve, 
that  the  chief  circumftance  to  be  taken  notice  of,  is 
the  inflamed  ftate  of  the  urethra,  which  I  take  to  be 
infcparable  from  the  difeafe. 

MDCCLXVI. 

In  thefe  well-known  circumftances,  the  gonorrhoea 
Continues  for  a  time  longer  or  fhorter,  according  to 
the  confutation  of  the  patient ;  it  ufually  remaining 
longefb  in  the  mofl  vigorous  and  robuft,  or  according 
to  the  patient's  regimen,  and  the  care  taken  to  relieve 
or  cure  the  difeafe.  In  many  cafes,  if  by  a  proper  re- 
gimen the  irritation  of  the  inflamed  fiafe  is  carefully 
avoided,  the  gonorrhoea  fpontaneouily  ccafes,  the 
fymptoms  of  inflammation  gradually  abating,  the  mat- 
ter difcharged  becoming  of  a  thicker  and  more  vifcid 
confidence,  as  well  as  of  a  whiter  colour  ;  till  at 
length,  the  flow  of  it  ceafes  altogether;  and  whether 
it  be  thus  cured  fpontaneoufly,  or  by  art,  the  difeafe 
often  exifls  without  communicating  any  infection  to, 
the  other  parts  of  the  body, 

MDCCLXVII, 

In  other  cafes,  however,  the  difeafe  having  been 
neglected,  or  by  an  improper  regimen  aggravated,  it 
continues  with  ail  its  fymptoms  for  a  long  time';  and 
produces  various  other  diibrders  in  the  genital  parts, 
which,  as  commonly  taken  notice  of  by  authors,  need 
not  be  defcribed  here.  I  fhall  only  obferve,  that  the 
inflammation  of  the  urethra,  which  at  firft  feems  to 

be 


OF    P  H  Y  S  I  C.  381 

be  feated  chiefly,  or  only,  in  its  anterior  parts,  is  in 
fuch  neglected  and  aggravated  cafes  fpread  upwards 
along  the  urethra,  even  to  the  neck  of  the  bladder. 
In  thefe  circumftances,  a  more  confiderablc  inflam- 
mation is  occafioned  in  certain  parts  of  the  urethra; 
and  confequently,  fuppuration  and  ulcer  are  produc- 
ed, by  which  the  venereal  poifon  is  fometimes  com- 
municated to  the  fyftem,  and  gives  rife  to  a  general 
fiphylis. 

MDCCLXVIII. 

It  was  fome  time  ago  a  pretty  general  fuppofition, 
that  the  gonorrhoea  depended  always  upon  ulcers  of 
the  urethra,  producing  a  difcharge  of  purulent  mat- 
ter \  and  fuch  ulcers  do  indeed  fome  times  occur  in 
the  manner  that  has  been  juft  now  mentioned  We 
are  now  affured,  however,  from  many  directions  of 
perfons  who  had  died  when  labouring  under  a  goncr- 
rhcea,  that  the  diieafe  may  exifl,  and  from  many  con- 
fiderations  it  is  probable  that  it  commonly  does  exifl:, 
xvithout  any  ulceration  of  the  urethra  ;  ib  that  the  dif- 
charge which  appears,  is  entirely  that  of  a  vitiated  mu- 
cus !rom  the  mucous  follicles  of  the  urethra. 
MDCCLXIX, 

Although  moil  of  the  fymptoms  of  gonorrhoea 
fliould  be  removed,  yet  it  often  happens  that  a  mu- 
cous fluid  continues  to  be  difcharged  from  the  urethra 
for  a  long  time  after,  and  fometimes  for  a  great  part 
of  a  perfon's  life.  This  difcharge  is  what  is  common- 
ly called  a  Gleet. 

With  refpecl  to  this,  it  is  proper  to  obferve,  that  in 
fome  cafes,  when  it  is  certain  that  the  matrer  difcharg- 
ed contains  no  venereal  poifon,  the  matter  may,  and 
often  does,  put  on  that  puriform  appearance,  and  that 
yellow  and  greenim  colour,  which  appears  in  the  dif- 
charge at  the  beginning  and  during  the  courfe  of  vi- 
rulent gonorrhoea.  Thefe  appearances  in  the  matter 
of  a  gleet,  which  before  had  been  of  a  lefs  coloured 

kind, 


332  PRACTICE 

kind,  have  frequently  given  occafion  to  fuppofc  that  a 
frem  infection  had  been  received :  but  I  am  certain 
that  fuch  appearances  may  be  brought  on  by,  per- 
haps, various  other  caufes ;  and  particularly,  by  in- 
temperance in  venery  and  drinking  concurring  toge- 
ther. I  believe,  indeed,  that  this  feldom  happens  to 
any  but'  thofe  who  had  before  frequently  laboured 
under  a  virulent  gonorrhoea,  and  have  more  or  lefs  of 
gleet  remaining  with  them :  but  I  mufl  alfo  otfferve, 
that  in  perfons  who  at  no  period  of  their  life  had  ever 
laboured  under  a  virulent  gonorrhoea,  or  any  other 
fymptom  of  fiphylitic  affection,  I  have  met  with  in- 
ftances  of  difcharges  from  the  urethra  refembling 
thofe  of  a  virulent  gonorrhoea. 

The  purpofe  of  thefe  obfervations  is,  to  fuggeft  to 
practitioners  what  I  have  not  found  them  always  aware 
of,  that  in  perfons  labouring  under  a  gleet,  fuch  a  re- 
turn of  the  appearances  of  a  virulent  gonorrhoea  may 
happen  without  any  new  infection  having  been  receiv- 
ed, and  confequemly  not  requiring  the  treatment 
which  a  new  infection  might  perhaps  demand.  When, 
in  the  cure  of  gonorrhoea,  it  was  the  practice  ta  em- 
ploy purgatives  very  frequently,  and  fometimes  thofe 
of  the  draftic  kind,  I  have  known  the  gleet,  or  fpuri- 
ous  gonorrhoea,  by  fuch  a  pra&ice  much  increafed 
and  long  continued,  and  the  patient's  conftiturion  ve- 
ry much  hurt.  Nay  in  order  more  certainly  further 
to  prevent  miftakes,  it  is  to  be  obferved,  that  the  fpu- 
rious  .gonorrhoea  is  fometimes  attended  with  heat  of 
urine/ and  fome  degree  of  inflammation;  buttthefe 
fymptorns  are  feldom  confiderable,  and,  merely  by 
the  arMance  of  a  cool  regimen,  commonly  difappear 
in  a  few  days. 

MDCCLXX. 

With  refpecl  to  the  cure  of  a  virulent  gonorrhoea, 
I  have  only  to  remark,  that  if  it  be  true,  as  I  have  men- 
tioned above,  that  the  difeafe  will  often,  under  a  pro- 
per 


OF      PHYSIC.  383 

per  regimen,  be  fpontaneouily  cured ;  and  that  the 
whole  of  the  virulent  matter  maybe  thus  entirely 
difcharged  without  the  affiftance  of  art ;  it  would 
feem  that  there  is  nothing  required  of  practitioners, 
but  to  moderate  and  remove  that  inflammation  which 
continues  the  difeafe,  and  occaiions  all  the  trouble- 
fome  fymptoms  that  ever  attend  it.  The  fole  bu- 
linefs  therefore  of  our  art  in  the  cure  of  gonorrhoea,  is 
to  take  off  the  inflammation  accompanying  it :  and 
this  I  think  may  commonly  be  done,  by  avoiding  ex- 
ercife,  by  ufing  a  low  and  cool  diet,  by  abftaining  en- 
tirely from  fermented  and  fpirituous  liquors,  and  by 
taking  plentifully  of  mild  diluent  drinks.* 

MDCCLXXL 

*  This  fimplc  method  of  curing  a  gonorrhoea  is,  in  many  cafes, 
fufficient,  but  it  can  only  be  depended  on  when  the  difeafe  is  flight 
and  the  patient  of  a  healthy  conltitution.  As  every  virulent  gonor- 
ihcea  is  evidently  produced  by  the  a&ion  of  the  venereal  poifon,  the 
judicious  practitioner  will  feldom  trull  to  this  method  without  the 
ufe  of  mercurials  after  the  inflammatory  fymptoms  have  been  fome 
what  fubdued.  They  ought  to  be  given  in  fuch  cafes  in  very  fmall 
quantities,  fo  as  to  produce  only  a  flight  effect  on  the  mouth  ;  and 
their  ufe  ought  to  be  continued  till  every  fymptoro-difappears. 

Mercury  may  be  ufed  internally  or  externally  as  occaiion  may  re- 
quire ;  if  it  does  not  affect  the  bowels  nor  purge,  the  common  mer- 
curial pill  of  the  Edenburgh  pharmacopcea  is  as  good  a  formula  as 
any  we  have  in  the  fhops.  It's  dofe  muit  be  regulated  by  the  effects 
it  produces.  In  general,  we  begin  with  a  four  grain  pill  every  night, 
and  continue  that  quantity  till  the  gums  be  flightly  affected,  or  a 
coppery  taftc  be  perceived  in  the  mouth.  When  either  of  thefe 
fymptoms  appear,  we  are  certain  that  the  mercury  is  received,  in  A 
fufficient  quantity,  into  the  general  mafs  of  the  blood,  for  deilroying 
the  venereal  virus,  and  then  a  pill  may  be  given  once  in  two  or  three 
days,  fo  as  to  keep  up  the  fame  flight  affection  of  the  mouth,  but 
without  increafing  it.  If  the  pill  purges,  we  then  are  to  have  rc- 
courfeto  the  ftrong  mercurial  ointment,  half  a  dram  of  which  muit 
be  rubbed  into  the  hams  night  and  morning,  till  the  mouth  be  af- 
fected in  the  manner  above  defcribed. 

The  patient  ought  to  wear  flannel  drawers  during  the  whole  time 
of  the  continuing  the  rubbing,  which  oaght  to  be  i emulated  by  the 
degree  of  affection  perceived  in  the  mouth.  The  ufe  either  of  the 
pill  or  of  friction  muft  be  continued  eight  or  tcti  days  after  every 
fymptom  of  the  difeafe  has  disappeared, 


384  PRACTICE 

MDCCLXXI. 

The  heat  of  urine,  which  is  fo  troublefome  in  this 
difeafe,  as  it  arifes  from  the  increafed  feniibi^y  of  the 
urethra  in  its  inflamed  {late  ;  fo,  on  the  other  hand,  the 
irritation  of  the  urine  has  the  effeft  of  incrcafmg  the 
inflammation,  and  is  therefore  to  be  removed  as  foon 
as  poffible*  This  can  be  done  moil  effectually  by  tak- 
ing in  a  large  quantity  of  mild  watery  liquors.  De- 
mulcents may  be  employed;  but  unlefs  they  be  ac- 
companied with  a  large  quantity  of  water,  they  will- 
have  litt  le  effecl.*  Nitre  has  been  commonly  employ- 
ed as  a  fuppofed  refrigerant .  but,  from  much  obfer- 
vation,  I  am  convinced,  that  in  a  fmall  quantity  it  is 
tifeieis,  and  in  a  large  quantity  certainly  hurtful* ;  and 
for  this  reafon,  that  every  faline  matter  palling  with 
the  urine  generally  gives  fome  irritation  to  the  urethra,, 
To  prevent  the  irritation  of  the  urethra  arifing  from 
its  increafed  feniibility,  the  injection  of  mucilage  or  of 
mild  oil  into  it  has  been  pra&ifed  j  but  i  have  feldom 
found  this  of  much  fervice* 

MDCCLXXII. 

In  gonorrhcea,  as  conftivenefs  may  be  hurtful,  both 
by  an  irritation  of  the  fyfteiii  in  general,  and  of  the 
urethra  in  particular,  as  this  is  occasioned  always  by  the 
avoiding  of  hardened  faeces  ;  fo  conitivenefs  is  to  be 
carefully  avoided  or  removed  ;  and  the  frequent  ufe  of 
large  glyfters  of  water  and  oil,  I  have  found  of  remar- 
kable benefit  in  this  difeafe.  If  glyfters,  however,  do 

hot 

*  Lintfeed-tca,a  very  thin  deco&ion  of  marm-mallow  root,  or 
thin  barley-water,  will,  in  moil  cafes,  anfwer  the  intention  fufiident- 
ly  well.  The  common  almond  emulfion  has  been  recommended  in 
thefe  cafes,  and  when  taken  in  large  quantities  is  certainly  very  effica- 
cious. It  may  be  ufed  as  the  patient's  common  drink. 

•j*  The  ufe  of  nitre  has  been  itrongly  recommended  by  many  practi- 
cal writers,  in  cafes  of  iimple  gonorrhoea  accompained  with  this  iymp- 
torn  ;  but  it  muft  be  acknowledged,  (as  the  author  jufdy  obfcrves,) 
to  be  hurtful  by  it's  irritating  quality.  It  is  certainly  a  rcfringefant^ 


OF      P    II    Y     S     I    C  385 

toot  entirely  obviate  coftivenefs,  it  will  be  ncceflary  to 
give  laxatives  by  the  mouth  :  which,  however,  iliould 
be  of  the  rnildeft  kind,  and  fiiould  do  no  more  than 
keep  the  belly  regular  and  a  little  Icofe,  without  much 
purging*. 

The  .pVa&jce  of  frequent  purging,  which  was  for- 
merly fo  much  in  ufe,  and  is  not  yet  entirely  laid  afide, 
has  always  appeared  to  me  to  be  generally  fuperfluous, 
and  often  very  hurtful.  Even  what  are  fuppofed  to 
be  cooling  purgatives,  fuch  as  Glauber's  fait,  foluble 
tartar,  and  crystals  of  tartar,  in  fo  far  as  any  part  of  them 
pafsby  urine,  they,  in  the  fame  manner  as  we  have  faid  of 
nitre,  may  be  hurtful ;  and  fo  far  as  they  produce  very  li- 
quid (tools,  the  matter  of  which  isgenerally  acrid,  they  ir- 
ritate the  rectum,  and  confequently  the  urethra.  This 
iaft  effect,  however,  the  acrid,  and  in  any  degree  draf- 
ric,  purgatives,  more  certainly  produce. 
MDCCLXXIIL 

In  cafes  of  a  gonorrhcea  attended  with  violent  infj  ani- 
mation, blood-letting  may  be  of  fervice  ;  and  in  the 
cafe  of  perfons  of  a  robufl  and  vigorous  habit,  in  whom 
the  difeafe  is  commonly  the  nioft  violent,  blood-letting 
may  be  very  properly  employed.  As  general  bleed- 
ings, however,  when  there  is  no  phlogiftic  diathefis  in 
the  fyftem,  have  little  effect  in  removing  topical  in- 
flammation ;  fo  in  gonorrhcea,  when  the  inflammation 
is  confiderable,  topical  bleeding  applied  to  the  urethra 

VOL,  II.  3  C  by 

and  as  fuch  is   allaying  the  inflammatory  fymptoms ;   but  it  is  insd- 
miflible  in  cafes  where  the  ardor  unnae  is  violent. 

*  A  tea-fpoonful  of  the    following  elc&uary  taken  occafionaily 
will  keep  the  belly  fuiEciently  open. 
]$,.  Pulv.  Jalap.  51. 

Nitri.  $\i. 
Elect.  Lenitiv.  §?. 
Syr.   Simpl.   q,   f. 
M.  f  ELft. 


336  PRACTICE 

by  leeches,  is  generally  more  effectual  in  relieving  the 
inflammation*. 

MDCCLXXIV. 

When  there  is  any  phymofis  attending  a  gonorrhoea, 
einolient  fomentations  applied  to  the  whole  penis  are 
often  of  fervice.  In  fuch  cafes  it  is  neceflary,  and  in 
all  others  ufeful,  to  keep  the  penis  laid  up  to  the  bel- 
ly, when  the  patient  either  walks  about  or  is  fitting^. 
MDCCLXXV. 

Upon  occailon  of  frequent  priapifoi  and  chordee,  it 
has  been  found  ufeful  to  apply  to  the  whole  of  the  pe- 
nis a  poultice  of  crumb  of  bread  moiflened  with  a 
ilrong  folution  of  fugar  of  lead.  I  have,  however, 
been  often  difappoinred  in  this  practice,  perhaps  by  the 
poultice  keeping  the  penis  too  warm,  and  thereby 
exciting  the  very  fymptoms  I  wiihed  to  prevent. 
Whether  lotions  of  the  external  urethra  with  a  folution 
of  the  fugar  of  lead,  might  be  ufeful  in  this  cafe,  I  have 
not  properly  triedf . 

MCCCLXXVI. 

With  refpect  to  the  ufe  of  injections,  fo  frequently 
employed  in  gonorrhoea,  I  am  perfuaded  that  the  early 
ufe  of  aftringent  injections  is  pernicious  j  not  by  oc- 

cafioning 

*  The  good  effe&s  ofleeches  in  thefe  cafes  are  confirmed  by  ex- 
perience.    They  may  be  applied  on  the  under  fide  of  the  penis,  and* 
three  or  four  thus  applied  have  freq-uently  produced  amazing  effeds. 
The  operation,  however,  is  extremely  painful,    and  is    feldom   fub- 
mitted  to  a  fecond  time  by  a  patient  who  has  once  experienced  it. 

§  In  all  cafes  of  inflammation  of  the  urethra  thefe  emollient  ap- 
plications give  great  relief.  The  common  white  bread  poultice  may- 
be ufed  during  the  night  time  or  while  the  patient  is  in  bed  ;  and, 
warm  flannels  impregnated  with  lintfeed-tea  while  he  is  fitting  up. 

f  The  fugar  of  lead  folution  may  perhaps  be  objected  againlt  on 
account  of  it's  flopping  the  difcharge,  and  inducing  a  fwelled  tefticle, 
which  has  fometimes  followed  it's  application.  Wrapping  the  penis 
up  in  linen  rags  wet  with  cold  water,  frequently  anfwers  the  purpofe 
of  preventing  the  violence  of  the  fymptoms,  as  well  as  any  more 
complicated  application.  The  cold  wet  rags  ought  to  be  renewed 
v/heneverthcy  grow  warm, 


OF    PHYSIC.  387 

cafioning  a  fiphylis,  as  has  been  commonly  imagined; 
but  by  increafing  and  giving  cccafion  to  all  the  confe- 
quences  of  the  inflammation,,  particularly  to  the  very 
troublefome  fymptoms  of  fwelled  tefticles.  When, 
however,  the  difeafe  has  continued  for  feme  time,  and 
the  inflammatory  fymptoms  have  very  much  abated,! 
am  of  opinion,  that  by  injections  of  moderate  aftrin- 
gency,  or  at  lead  of  this  gradually  increafed,  an  end 
may  be  fooner  put  to  the  difeafe  than  would  other- 
wife  have  happened  ;  and  that  a  gleet,  fo  readily  oc- 
curring, may  be  generally  prevented*. 

MDCCL  XXVII. 

Befides  the  ufe  of  aftringent  injections,  it  has  been 
common  enough  to  employ  thofe  of  a  mercurial  kind. 
With  refpecl  to  thefe,  although  I  am  convinced  that 

3  C  2  the 

*  The  practice  of  ufing  aftringent  inje&ions  is  extremely  com- 
mon ;  but,  fas  the  author  julUy  obferves,)  their  ufe  is  frequently  at- 
tended with  difagreeable  confequences.  In  general  they  do  harm 
when  ufed  during  the  continuance  of  the  inflammatory  fymptoms, 
or  even  too  foon  after  thefe  fymptoms  have  difappeared.  If,  how- 
ever, (after  the  inflammatory  fymptoms  are  overcome,  and  mercury 
has  been  ufed  for  fix  weeks  or  two  months  rn  the  manner  defcrib^tl 
in  the  note  on  article  1770,)  the  Tunning  dill  continues,  we  may 
then  have  recotirfe  to  thefe  aftringent  injections.  They  may  be  made 
of  fugar  of  lead  and  white  vitriol  well  diluted  with  water  as  in  the 
following  : 

$>    Sacch.   Saturn, 

Vitriol,  alb.    a  a  3^*« 
Aq.  font,    Jfviii. 
M.  et  cola  per  chartsm. 

Half  an  ounce  of  this  injeftion  {lightly  warmed  may  be  thrown 
up  in  the  urethra  twice  a-day  ;  but  if  it  produce  any  fmarting,  it 
ought  to  be  diluted  with  more  water, 

Solutions  of  copper  have  alfo  been  ufed  with  advantage  in  thefe 
cafes,  but  they  are  of  fo  corrofive  a  nature,  as-. frequently  to  do  harm, 
if  not  very  much  diluted. 

An  imprudent  or  too  frequent  ufe  of  any  thefe  injections,  efpeciaily 
if  they  are  too  ftror.g  or  not  flifficiently  diluted,  fometime's  inflames 
or  even  excoriates  the  urethra,  and  hence  much  mifchtef  arifes.  The 
cautious  practitioner  rr.uft  therefore  never  ufe  them  fo  ilrong  as  to 
produce  much  fmaiting. 


388  PRACTICE 

the  infection  producing  gonorrhoea,  and  that  produc- 
ing chancres  and  fiphylis,  are  one  and  the  fame  ;  yet 
I  apprehend,  that  in  gonorrhoea  mercury  cannot  be  of 
life  by  correcting  the  virulence  of  the  infection  ;  and 
therefore  that  it  is  not  univerfally  necefiary  in  this 
difeafe.  I  am  perfuaded,  however,  that  mercury  ap- 
plied to  the  internal  furface  of  the  urethra,  may  be  of 
ufe  in  promoting  the  more  full  and  free  difcharge  of 
virulent  matter  from  the  mucous  glands  of  it.  Upon 
this  fuppofuion,  I  have  frequently  employed  mercu- 
rial injections  ;  and,  as  1  judge,  with  advantage  ; 
thofe  injections  often  bringing  on  fuch  a  (late  of  the 
confidence  and  colour  of  the  matter  discharged,  as  we-- 
know  ufually  to  precede  its  fpontaneous  ceaiing.  I 
avoid  triefe  injections,  however,  in  recent  cafes,  or 
while  much  inflammation  is  iiill  prefent  ;  but  when 
that  inflammation  has  fomewhat  abated,  and  the  dif- 
charge  notwithftanding  dill  continues  in  a  virulent 
form,  I  employ  mercurial  injections  freely.  I  employ 
thofe  only  that  contain  mercury  entirely  in  a  liquid 
form,  and  avoid  thofe  which  may  depofite  an  acrid 
>.oweder  in  the  urethra.  That  which  I  have  found 
in  oft  ufeful  is  a  folution  of  the  corrofive  fublimate  in 
\vater;  fo  much  diluted  as  not  to  cccaiion  any  violent 
fniarting,  but  not  fo  much  diluted  as  to  give  no  fmarc- 
ing  at  all.  It  is  fcarce  neceffary  to  add,  that  when 
there  is  reafon  to  fufpect  there  are  nice  rations  already 
formed  in  the  urethra,  mercurial  injections  are  not 
only  proper,  but  the  only  effectual  remedy  that  can 
be  employed. 

MDCCLXXVIII. 

V/ith  regard  to  the  cure  of  gonorrhoea,  I  have  only 
one  other  remark  to  offer.  As  mofl  of  the  fymptoms 
urife  from  the  irritation  of  a  (limultis  applied,  the  ef- 
fects of  this  irritation  may  be  often  leaned  by  dimi- 
nifhing  the  irritability  of  the  fyilem  ;  and  it  is  well 
known,  that  the  molt  certain  means  of  accompli (h ing 

this 


OF    PHYSIC.  389 

this  is  by  employing  opium.  For  that  reafon,  I  con- 
ilder  the  practice  both  of  applying  opium  directly  to 
the  urethra*,  and  of  exhibiting  it  by  the  mouth,  to 
be  extremely  ufeful  in  moft  cafes  of  gonorrhoea* 

MDCCLXXIX. 

After  thus  offering  feme  remarks  with  refpect  to  go- 
norrhoea in  general,  I  might  proceed  to  conficier  par- 
ticularly the  various  fymptoms  which  ib  frequently  at- 
tend it ;  but  it  does  not  feern  neceilary  for  me  to  at- 
tempt this  after  the  late  publications  of  Dr.  Foart 
Simmons,  and  of  Dr.  Schwediaur,  who  have  treated 
the  fubject  fo  fully,  and  with  fa  much  difcernment 
nnclikillj. 

MDCCLXXXI. 


1 


*  Opium  may  be  very  conveniently  applied  to  the  urethra  by  in- 
jeclion  ;  and  for  this  purpofe  a  diluted  folution  of  opium  in  water 
is  preferable  to  a  fpirituous  or  vinous  folution.  A  grain  of  opium 
ditTolved  in  an  ounce  of  water,  and  the  fohuion  drained,  may  be  in- 
jected twice  or  thrice  a-day  ;  and  thirty  or  forty  drops  of  laudanum 
may  be  given  every  night  at  bed-time. 

§  Asa  fwelled  tefiicle  frequently  attends  a  fupprefftrd  (ronorrhcea, 
it  may  be  proper  to  give  the  young  practitioner  fame  directions  con- 
cerning the  management  of  it. 

Sometimes  without  any  other  preceding  fymptom,  but  generally 
on  a  premature  (topping  of  a  gonorrhoea,  a  pain  is  felt  in  the  fprr- 
matic  veffels  and  epididymis.  The  pair,  continuing,  the  veiTels  and 
ep'ciidyrnis  begin  to  fvvell,  and  the  pain  and  f  welling  are  foon  com- 
municated  to  the  tefticle. 

In  thefe  cafes,  we  mult  confine  the  patient  to  his  bed,  bleeding 
liim  if  the  inflammatory  diathefis  appears  to  be  univerfal  ;  but,  if 
not,  three  or  four  leeches  may  be  applied  to  the  inflamed  part.  A 
brifk  purge  mud  be  given,  for  which  purpofe  an  ounce  of  .Glauber's 
Salt,  with  a  large  quantity  of  water,  anfwcrs  fufficienlly  well.  Gold 
pledgets  foaked  in  a  folution  of  Sugar  of  Lead,  ckicribed  in  the 
note  on  article  267.  muft  be  applied  to  the  Scrotum,  and  then  place 
iupplied  with  frefh  cold  ones,  as  often  as  they  grow  warm  by  lying 
on  the  parts.  A  warm  poultice  of  bread  and  milk,  muft  be  alfo  ap- 
plied to  the  glans  penis  or  to  the  whole  penis.  The  patient  muft  be 
kept  on  aver)  fpare  diet,  ufmg  fot  his  drink  cold  water  with  a  fcru- 
jle  of  nitre  in  each  pint  of  it.  This  regimen  generally  allays  the 
violence  of  the  fymptoms,  within  twenty  four  hours  ;  but,  it  will 
ke  neccffary  to  continue  the  ufe  of  the  cold  pledgets  and  warm  poul- 


33o  PRACTICE 

MDCCLXXX. 

The  other  form  of  the  local  affeclion  of  fiphylls,  is 
that  of  chancre.  The  ordinary  appearance  of  this  I 
need  not  defcribe,  it  having  been  already  fo  often  done. 
Of  the  few  remarks,  I  have  to  offer,  the  firft  is,  that  1 
believe  chancres  never  appear  in  any  degree  without 
immediately  communicating  to  the  blood  more  or  lefs 
of  the  venereal  poiibn  ;  for  I  have  conftantly,  when- 
ever chancres  has  appeared,  found,  that  unlefs  mer- 
cury was  immediately  given  internally,  fome  fymp- 
toms  of  a  general  fiphylis  did  certainly  come  on  after- 
wards ;  and  though  the  internal  ufe  of  mercury  fhould 
prevent  any  fuch  appearance,  it  is  (till  to  be  prefumed 
that  the  poifon  had  been  communicated,  becaufe  mer- 
cury could  act  upon  it  in  no  other  manner  than  as  dif- 
fufed  in  the  fluids, 

MDCCLXXXI. 

It  has  been  a  queftion  among  pra&itioners,  upoa 
the  fubjecl  of  chancres,  Whether  they  may  be  imme- 
diately healed  up  by  applications  made  to  the  chancres, 
or  if  they  fhould  be  left  open  for  fome  time  without 
any  fuch  application  ?  It  has  been  fuppofed,  that  the 

ftidden 

tice  for  three  or  fcmr  days  or  longer,  and  to  repeat  the  purge.  After 
the  pain  and  fwellinghave  been  completely  removed,  the  patient  may 
fit  up,  hut  it  will  be  prudent  for  him  to  ufe  a  fufpenfory  bandage  for 
the  fcrotum,  as  the  'weight  of  the  tefticles,  by  ftretching  fpermatics 
cords  will  be  apt  to  occafion  the  return  of  all  the  fymptoms. 

Sometimes  the  gonorrhoea, if  it  has  preceded  the  fvvellings  of  the 
eptdidymis  and  telHcles,  will  be  a^ain  brought  on  ;  but,  it  likewife 
fometimes  happens  that,  on  difcuffing  the  tumor  in  the  fcrotnm  the 
glands  of  the  groin  begin  to  be  painful  and  to  fweil.  In  thefc  cnfes 
we  mull  apply  cold  p'edgets  to  thefe  glands  as  well  as  to  the  fcro- 
tu.n  ;  and  rub,  at  the  fame  time,  fome  ftrong  mercurial  ointment  on 
the  infide  of  the  thighs,  in  the  courfe  of  the  lymphatics  going  to 
thefe  glands  ;  and,  if  the  penis  be  not  inflamed,  half  a  dram  or  a. 
fcruple  of  mercurial  ointment  ought  to  be  rubbed  on  the  bafe  of  the 
glans  penis  in  the  inllde  of  the  prepuce. 

Mich  is  the  general  method  of  treating  cafes  of  this  kind,  and  a 
deat  continuance  of  it  fcldom  fail  of  fuccefs. 


OF    PHYSIC. 

fudden  healing  up  of  chancres  might  immediately 
force  into  the  blood  a  poifon,  which  might  have  been 
excluded  by  being  difcharged  from  the  chancre. 
This,  however,  is  a  iuppofitioii  that  is  very  doubtful  ; 
and,  upon  the  other  hand,  I  am  certain,  that  the  long- 
er a  chancre  is  kept  open,  the  more  poifon  it  perhaps 
generates,  and  certainly  fupplies  it  more  copioufly  to 
the  blood.  And  although  the  above-mentioned  fuj> 
pofnion  were  true,  it  will  be  cf  little  confequence,  if 
the  internal  ufe  of  mercury,  which  I  judge  neceffury 
in  every  cafe  of  chancre,  be  immediately  employed. 
I  have  often  feen  very  troublefome  confequences  fol- 
low from  allowing  chancres  to  remain  unhealed  ;  and 
the  fymptoms  of  general  fiphylis  have  always  feerned 
to  me  to  be  more  coniiderable  and  violent  in  propor- 
tion as  chancres  had  been  fuffervd  to  remain  longer 
unhealed  :  They  fhould  always,  therefore,  be  healed 
as  foon  as  poflible  ;  and  that  by  the  only  very  cffeclu- 
al  means,  the  application  of  mercurials  to  the  chancre 
itfelf.  Thofe  that  are  recent,  and  have  not  yet  form- 
ed any  confiderable  ulcer,  may  often  be  healed  by  the 
common  mercurial  ointment ;  but  the  mod  powerful 
means  of  healing  them  has  appeared  to  me,  to  be  the 
application  of  red  precipitate  in  a  dry  powder*. 

MDGCLXXXIL 

*  Although  chancres  may  be  very  fpeedily  healed  by  red  preci- 
pitate alone,  yet  it  will  be  ncceffary  fomnimes  to  ufe  anointment 
made  of  the  red  precipitate  and  twice  or  thrice  it's  weight  of  frefh 
hogs  lard.  The  precipitate  will  by  this  means  be  more  conftantly 
kept  OM  the  part.  The  practitiower,  however,  mult  be  cautious  left 
he  ufe  too  great  a  quantity  of  precipitate,  which,  by  it's  corrofive 
quality,  fometimes  iucreafes  the  ulcer  it  was  meant  to  heal. 

During  the  ufe  of  this  application,  it  will  be  neceffary  alfo  to  ufc 
mercury  either  internally  or  externally,  in  the  manner  defcribcd  in 
the  note  on  article  1770. 

The  application  of  the  laps  infernalis  to  chancres,  comes  recom- 
mended 10  us  on  the  authority  of  fume  eminent  practitioners.  It 
is  however  a  dangerous  application,  and  frequently  produces  ulcers 
that  arc  extremely  difficult  to  heal. 


39*  PRACTICE 

MDCCLXXXII. 

When,  in  confequence  of  chancres,  Or  of  the  other 
circumftances  above  mentioned,  by  which  it  may  hap-* 
pen  the  venereal  poifoa  has  been  communicated  to  the 
blood,  it  produces  many  different  fymptoms  in  differ-* 
ent  parts  of  the  body,  not  neceffary  to  be  enumerated 
and  defcribed  here,  that  having  been  already  done  by 
many  authors  with  great  accuracy. 
MDCCLXXXIII. 

Whenever  any  of  thofe  fymptoms  do  in  any  degree 
appear,  or  as  foon  as  it  is  known  that  the  circumftan- 
ces which  give  occafion  to  the  communication  of  the 
venereal  poifon  has  taken  place,  I  hold  the  internal  ufe 
of  mercury  to  be  immediately  neceffary;  and  I  am  well 
perfu-aded,  that  mercury  employed  without  delay,  and 
in  fufficient  quantity,  will  pretty  certainly  prevent  the 
fymptoms  which  would  other  wife  have  foon  appeared^, 
or  will  remove  thofe  that  may  have  already  discovered 
themfelves.  In  both  cafes,  it  will  fecure  the  perfoit 
from  any  future  confequences  of  fiphylis  from  that  in- 
feel  ion. 

MDCCLXXXIV. 

This  advice  for  the  early  and  full  ufe  of  mercury,  I 
take  to  be  the  mod  important  that  can  be  given  with 
refpectto  the  venereal  difeafe ;  And  although  I  muft 
admit  that  the  virulence  of  the  poifon  may  be  greater 
in  one  cafe  than  in  another,  and  even  that  one  confti- 
tution  may  be  more  favourable  than  another  to  the 
•  violence  of  the  difeafe  ;  yet  I  am  thoroughly  con- 
vinced, that  mod  of  the  inftances  which  have  occurred 
of  the  violence  and  obflinacy  of  fiphylis  have  been 
owing  very  entirely  to  the  neglect  of  the  early  appli- 
cation ef  mercury*. 

MBCCLXXXV. 

*  In  a  word,  mercury  is  a  certain  fpecific  for  fiphylis,  and  a  fare 
antidote  againit  the  venereal  poifon  *  If  it  be  propeily  uied.  it  fel- 
ciom  fails  of  producing  a  cure  ;  and  this  cure  will  always  be  more 


OF     PHYSIC.  393 

MDCCLXXXV. 

Whatever  other  remedies  *  of  fipbylis  may  be 
known,  or  may  hereafter  be  found  out,  I  cannot  pre- 
tend to  determine;  but  I  am  well  perfuaded,  that  in 
mo  ft  cafes  mercury  properly  employed  will  prove  a 
very  certain  and  effectual  remedy.  With  refpect  to 
others  that  have  been  propofed,  I  ihall  offer  this  remark 
only,  that  I  have  found  the  decoction  of  the  meze- 
reon  contribute  to  the  healing  of  ulcers  which  feem- 
cd  to  have  refilled  the  power  of  mercury. 
MDCCLXXXVL 

Wkh  regard  to  the  many  and  various  preparations 
of  mercury,  I  dp  not  think  it  neceflary  to  give  any 
enumeration  of  them  here,  as  they  are  commonly  ve- 
ry well  known,  and  have  been  lately  well  enumerated 
by  Dr.  Schwediaur.  The  choice  of  them  feeins  to  be 
for  the  moil  part  a  matter  of  indifference;  as  I  believe 
cures  have  been,  arid  ftill  may  be,  effected  by  many 
different  preparations,  if  properly  adminiitered.  The 
proper  adminirtration§  feems  to  confift,  i/2,  In  the 
choofing  thofe  preparations  which  are  the  lead  ready 
to  run  off  by  (tool ;  and  therefore  the  applications  ex- 
ternally by  unction  are  in  many  cafes  the  mod  conve- 
nient, 2^/jf,  In  employing  the  unction,  or  in  giving* 
a  preparation  of  mercury  internally*  in  fuch  quantity 
as  may  (how  its  feniible  effects  in  the  mouth*  And 
^dly,  without  carrying  thefc  effects  to  a  greater  length, 
In  the  continuing  the  employment  of  mercury  for  fe- 
veral  weeks,  or  till  the  fymptoms  of  the  difeafe  fhali 
have  for  feme  lime  entirely  "difappeared.  I  fay  no- 

VOL.  II.  3  I)  thing 

fpesdy,  in  proportion,  as  rnejycury  has  been  ufcd  In  the  earlier  ftage 
of  the  dtfeafe. 

*  We  have  no  occafion  tofeek  for  other  remedies  than  mercury  : 
and  the  praftitioner  \vho  rifles  his  patient's  health,  and  his  own  re- 
putation, on  the  uncertain  effects  of  other  remedies*  furdy  de/ervca 
reprchenfion. 

§  Seethe  notes  OP.  Article  i 


394 


PRACTICE 


thing  of  the  regimen  proper  and  neceffary  for  patients 
during  the  employment  of  mercury,  becaufe  I  prefume 
it  to  be  very  well  known. 

MDCCLXXXVIL 

Amongft  the  other  preparations  of  mercury,  I  be- 
lieve the  corrofive  fublimate  has  often  been  employed 
with  advantage  :  but  I  believe  alfo,  that  it  requires  be- 
ing continued  for  a  longer  time  than  is  necefiary  in 
the  employment  of  other  preparations  in  the  manner 
above  propofed  ;  and  I  fufpect  it  has  often  failed  in 
making  a  cure,  becaufe  employed  while  perfons  were 
at  the  fame  time  expofed  to  the  tree  air. 
MDCCLXXXV1II. 

Upon  thefe  points,  and  others  relative  to  the  admi- 
niftration  of  mercury,  and  the  cure  of  this  difeafe,  I 
might  offer  feme  particular  remarks  :  but  I  believe 
they  are  generally  underflood  ;  and  it  is  enough  for 
me  to  fay  here,  that  if  practitioners  will  attend,  and 
patients  will  fubmit,  to  the  general  rules  given  a 
they  will  feldom  fail  of  obtaining  a  certain  and 
cure  of  the  difeafe. 


C     II     A     P.         IIL 

OF        S    C    U    R    V    Y. 

MDCCLXXXIX. 

THIS  difeafe  appears  fo  frequently,  and  the  effects 
of  it  are  fo  often  fatal  in  fleets  and  armies,  that 
it  has  very  properly  engaged  the  particular  attention 
of  phyficians.  It  is  indeed  furprifing  that  it  had  not 
fooner  attracted  the  efpecial  notice  both  of  flatefmeri 
and'phyficianSj  fo  as  to  have  produced  thofe  meafures 

and 


OF,     PHYSIC.  395 

and  regulations  that  might  prevent  ihc  havock  which 
it  fo  often  occafions.  Within  thefe  lad  fifty  years, 
however,  it  has  been  fo  much  attended  to  and  ftudied, 
that  we  might  fuppofe  every  circumftance  relating  to 
it  fo  fully  and  exactly  afcertained,  as  to  render  all  fur- 
ther labour  upon  the  fubject  fuperfluous.  This  per- 
haps may  be  true  ;  but  it  appears  to  me,  that  there  are 
flill  feveral  circumftances,  regarding  the  difeafe  not 
agreed  upon  among  phyficians,  as  well  as  different  opi- 
nions formed,  feme  cf  which  may  have  a  bad  effect 
upon  the  practice  ;  and  this  feems  to  me  to  be  fo 
much  the  caxre,  that  I  hope  I  {hall  be  excufed  in  endea- 
vouring here  to  Hate  the  facts  as  they  appear  to  me 
from  the  bed  authorities,  and  to  offer  remarks  upon 
opinions  which  may  influence  the  practice  in  the  pre- 
vention and  cure  of  this  difeafe. 
MDCCXC. 

With  refpect  to  the  phenomena  of  the  difeafe,  they 
have  now  been  fo  fully  obferved,  and  fo  accurately 
defcribed,  thai  there  is  no  longer  any  doubt  in  difcern- 
ing  the  difeafe  when  it  is  prefent,  or  in  diftinguifhing 
it  from  almoft  every  other  aliment.  In  particular,  it 
feems  now  to  be  fully  determined,  that  there  is  one 
difeafe  only,  intitled  to  the  appellation  of  Scurvy  ; 
that  it  is  the  fame  upon  the  laud  as  upon  the  fea  ;  that 
it  is  the  fame  in  all  climates  and  fcafons,  as  de- 
pending every  where  upon  nearly  the  fame  caufes; 
and  that  it  is  not  at  all  diveifified,  either  in  its  pheno- 
mena or  its  caufes,  as  had  been  imagined  fom.e  time 
ago. 

MDCCXCI. 

The  phenomena  of  icurvy,  therefore,  are  not  to  be 
defcribed  here,  as  it  has  been  fo  fully  and  accurately 
done  elfe where  ;  and  I  fhall  only  endeavour  to  afcer- 
tain  thofe  fads  with  refpect  to  the  prevention  and  cuie 
of  the  difeafe  which  feem  not  yet  to  be  exactly  a- 
grecd  upon.  And,  firft,  with  refpect  to  the  antece- 

3  I>  2-  dents 


P  R  A  C  T  I  C  E 

dents  that  may  be  coniidered  as  the  remote  cauies  of 
the  difeafe. 

MDCCXCII. 

The  mod  remarkable  circurnftances  amongft  the 
antecedents  of  this  difeafe  is,  that  it  has  moft  common- 
ly happened  to  men  living  very  much  on  faited  meats ; 
and  whether  it  ever  arife  in  any  other  circtimftances, 
is  extremely  doubtful.  Thefe  meats  are  often  in  a 
putrefcent  ftate ;  and  to  the  circumftance  of  the  long 
continued  ufe  of  animal  food  in  a  putrefcent  and 
ibmewhst  indigeftive  (late,  the  difeafe  has  been  efpe- 
cially  attributed.  Whether  the  circumftances  of  the 
meat's  being  faited,  has  any  effect  in  producing 
the  difeafe,  other  wile  than  by  being  rendered  more 
indigeftible,  is  a  queftion  that  remains  ftill  in  difpute. 
MDGGXC1IL 

It  feerns  to  me,  that  the  fait  concurs  in  producing 
the  effecl ;  for  there  is  hardly  any  inftance  of  the  dif- 
eafe appearing  unlefs  where  fait  meats  had  been  em- 
ployed, and  fcarcely  an  example  where  the  long  conti- 
nued ufe  of  thefe  did  not  produce  it ;  befides  all  which, 
there  are  fome  inftances  where,  by  avoiding  faited 
meats,  or  by  diminifhing  the  proportion  ol  them  in  di- 
et, while  other  circumftances  remained  much  the 
lame,  the  difeafe  was  prevented  from  appearing.  Fur- 
ther, if  it  may  be  admitted  as  an  argument  upon  this 
fubjecl,  I  /hall  hereafter  endeavour  to  ihow,  that  the 
large  ufe  of  fait  has  a  tendency  to  aggravate  and  in- 
creafe  the  proximate  caufe  oficurvy. 
MDCCXC1V. 

It  mud,  however,  be  allowed,  that  the  principal 
circumftance  in  cauiing  fcurvy,  is  the  Jiving  very  much 
and  very  long  upon  animal  food,  efpecially  when  in  a 
putrefcent  ftate  ;  and  the  clear  proof  of  this  is,  that  a 
quantity  of  frelli  vegetable  food  will  always  certainly 
prevent  the  difeafe, 

MDCCXtV, 


OF    PHYSIC.  397 

MDCCXCV. 

While  it  has  been  held,  that,  in  thofe  circumftances 
In  which  fcurvy  is  produced,  the  animal  food  employ- 
ed was  efpecially  hurtful  by  its  being  of  difficult  digek 
lion,  this  opinion  has  been  attempted  to  be  confirm- 
ed, by  obferving,  that  the  reft  of  .the  food  employed 
in  the  fame  circumftances  was  alfo  of  difficult  digefti- 
on.  This  is  ftippofed  to  be  efpecially  the  cafe- of 
unfermented  farinacea  which  fo  commonly  makes  a 
part  of  the  fea-diet.  But  I  apprehend  this  opinion  to 
be  very  ill-founded  ;  for  the  unfermented  jfarinacea, 
which  are  in  a  great  proportion  the  food  of  infants,  of 
women,  and  of  the  greater  part  of  mankind,  can  hard- 
ly be  fuppofed  to  be  food  of  difficult  diueition  :  and 
with  refpect  to  the  production  of  fcurvy,  there  are 
facts  which  fhow,  that  unfermented  farinacea,  em- 
ployed in  large  proportion,  have  had  a  conilderable 
effect  in  preventing  the  difeafe. 

MDCCXCVL 

It  has  been  imagined,  that  a  certain  impregnation  of 
the  air  upon  the  fea  had  an  effect  in  producing  fcurvy. 
But  it  is  altogether  improbable  :  for  the  only  impreg- 
nations which  could  be  fufpected,  are  thofe  of  inflam- 
mable or  mephitic  air ;  and  it  is  now  well  known, 
t hat  thefe  impregnations  are  much  lefs  in  the  air  upon 
the  fea  than  in  that  upon  the  land  ;  beiides,  there  are 
otherwife  many  proofs  of  the  falubrity  of  the  fea- air. 
If,  therefore,  fea-air  have  any  effect  in  producing 
fcurvy,  it  mud  be  by  its  feniible  qualities  of  cold  or 
nioiilure. 

MDCCXCVII. 

That  cold  has  an  effect  in  favouring  the  production 
of  fcurvy  5  is  man  if  eft  from  hence,  that  the  difeafe  is 
more  frequent  and  more  confidcrable  in  cold  than  in 
warm  climates  and  feafons  ;  and  that  even  warm 
ploathing  has  a  confiderable  effect  in  preventing  ic. 

Mbccxcvai. 

Moifture  may  in  general  have  an  effect  in  favouring 

the 


PRACTICE 

the  production  of  fcurvy,  where  that  of  the  atmofphcre 
in  which  men  are  placed  is  very  confiderable  :  but  the 
ordinary  moiiture  of  the  lea-air  is  far  from  being  fuch. 
Probably  it  is  never  confiderable,  except  in  the  cafe 
of  unufual  rains;  and  even  then  it  is  perhaps  by  the 
application  of  moiflure  to  the  bodies  of  men  in  damp 
cloathing  only  that  it  has  any  fhare  in  the  produc- 
tion of  fcurvy.  At  the  fame  time,  I  believe,  there 
is  no  inflance  of  either  cold  or  moiflure  producing 
fcurvy,  without  the  concurrence  of  the  faulty  fea- 
diet. 

MDCCXCIX. 

Under  thofe  circumftances  which  produce  fcurvy,  it 
commonly  feems  to  occur  moft  readily  in  the  perfons 
who  are  the  leaft  exercifed  ;  and  it  is  therefore  proba- 
ble, that  confinement  and  want  of  exercife  may  have  a 
great  fhare  in  producing  the  difeafe. 
MDCCC. 

It  appears  that  weakneft,  in  whatever  manner  occa- 
fioned,  is  favourable  to  the  production  of  fcurvy.  It 
is  therefore  probable,  that  unufual  labour  and  fatigue 
may  often  have  fome  fhare  in  bringing  it  on  :  and 
upon  the  fame  account,  it  is  probable,  that  fadnefs  and 
ciefpondency  may  induce  a  weaknefs  of  the  circula- 
tion ;  and  thereby,  as  has  been  remarked,  favourable 
to  the  production  of  fcurvy. 

MDCCCI. 

It  has  alfo  been  obferved,  that  perfbns  negligent 
in  keeping  their  fkin  clean  by  warning  and  change  ot 
cloathing,  are  more  liable  than  others  to  be  affc&ed 
with  fcurvy. 

MPCCCII. 

Several  of  thefe  caufes,  now  mentioned,  concurring 
together,  feem  to  produce  fcurvy  ;  but  there  is  no  pro- 
per evidence  that  any  one  of  them  alone  will  produce 
it,  or  that  all  the  others  uniting  together  will  do  it, 
without  the  particular  concurrence  of  the  fea-diet. 
Along  with  this,  however,  feveral  of  the  other  circum- 
ftances 


OF    PHYSIC.  359 

fiances  mentioned  have  a  great  efFed:  in  producing  it 
iboner,    and    in    a    more   considerable   degree,    than 
would  otherwife  have  happened  from  the  diet  alone. 
MDCCCIII. 

From  this  view  of  the  remote  caufes,  it  will  readily 
appear,  that  the  prevention  of  the  difeafe  may  in 
fome  meafure  depend  upon  the  avoiding  of  thofe  cir- 
cumftances  which  we  have  enumerated  as  contributing 
to  bring  on  the  difeafe  fooner  than  it  would  otherwife 
come  on.  At  the  fame  time,  the  only  effectual  means 
will  be,  by  avoiding  the  diet  of  falted  meats ;  at  lead 
by  leflcning  the  proportion  of  thefe,  and  ufing  meat 
preferved  othervvife  than  by  fait  ;  by  uiing  in  diet 
any  kind  of  efculent  vegetable  matter  that  can  be  ob- 
tained ;  and  eipecially  by  ufing  vegetable  matters  the 
rnoft  difpofed  to  acefcency,  fuch  as  malt ;  and  by 
drinking  a  large  quantity  of  pure  water. 
MDCCCiV. 

The  cure  of  fcurvy  feems  now  to  be  very  well  af- 
certained  ;  and  when  the  neceflary  means  can  be  ob- 
tained, the  difeafe  is  commonly  removed  very  quick- 
ly. The  chief  means  is  a  food  of  frefh  and  fucculent 
vegetables,  and  thofe  almoft  of  any  kind  that  are  at 
all  efculent.  Thofe  molt  immediately  effectual  are 
the  acid  fruits,  and,  as  being  of  the  fame  nature,  all 
fort  of  fermented  liquor. 

MDCCCV.  < 

The  plants  named  alkaltfcent,  fuch  as  thofe  of  the 
garlic  tribe  and  of  the  tetradynamiae*,  arc  dfo  parti- 
cularly 

*  The  plants  of  thisclafs  ought  to  be  ufed  in  large  quantities,  and 
raw.  The  more  a&ive  fpecies  are,  Horfe-radifh,  Muftard,  Water- 
rrcfs,  garden-crcfs,  Scurvy  grafs  :  The  milder  fpecits  are,  Hadi&es, 
Turnips,  Cabbages,  Cauliflowers,  Brocoll,  &c. 

To  the  above  lift,  may  be  added  fome  other  antifcorbutics  ofdif- 
fereut  clafies  ;  as  Malt,  Spinach,  Beet,  Carrots,  Celery,  Endive, 
Lettuce,  Afparagus,  the  young  (hoots  of  Hops,  Purfiain,  with  fe- 
veral  others.  All  thefe  frefli  vegetables  muit  be  eaten  in  large  quan- 
tities ;  they  ought  indeed  to  conllitute  the  patient's  chief  food,  an'd 
las  drink  may  be  aficfh  infufion  of  malt. 


400  P  R  A  C  T  I  C  £ 

cularly  ufeful  in  the  cure  of  this  difeafe;  for,  notwith- 
ftanding  their  appellation,  they  in  the  firft  part  of 
their  fermentation  undergo  an  afcency,  and  feern  to 
contain  a  great  deal  of  acefcent  matter.  At  the  fame 
time,  they  have  generally  in  their  compofition  an 
acrid  matter  that  readily  paries  by  urine,  probably  by 
perfpiration  ;  and  by  promoting  both  excretions,  arc 
ufeful  in  the  difeafe.  It  is  probable,  that  fome  plants 
of  the  coniferous  tribe,  luch  as  the  fpruce  fir,  and 
other  poiTcfled  of  a  diuretic  power,  may  iikewife  be  of 
fome  ufe. 

MDCCCVI. 

It  is  fufEciently  probable,  that  milk  of  every  kind, 
and  particularly  its  productions  whey  and  butter-milk, 
may  prove  a  cure  of  this  difeafe. 
MDCCCVII. 

It  has  been  common  in  this  difeafe  to  employ  the 
foflil  acids  ;  but  there  is  reafon  to  doubt  if  they  be  of 
any  fervice,  and  it  is  certain  they  are  not  effectual  re- 
medies. They  can  hardly  be  thrown  in  fuch  quan- 
tity as  to  be  ufeful  in  antifeptics  ;  and  as  they  do  not 
feem  to  enter  into  the  compofition  of  the  animal  flu- 
ids, and  probably  pafs  off  unchanged  by  the  excreti- 
ons, fo  they  can  do  little  in  changing  the  ftateof  the 
fluids. 

MDCCCVUI. 

The  great  debility  which  constantly  attends  fcurvy$ 
has  naturally  led  phyficians  to  employ  tonic  and 
flrengthening  medicines,  particularly  the  Peruvian 
bark  ;  but  the  efficacy  of  it  feems  to  me  very  doubt- 
ful. It  is  furpriiing  how  foon  the  ufe  of  a  vegetable 
diet  reftorcs  tile  ftrength  of  icorbutic  perfons ;  which 
feems  to  (how  that  the  preceding  debility  had  depend- 
ed upon  the  (late  of  the  fluids ;  and  coniequently,  till 
the  found  (late  of  thefe  can  be  restored,  no  tonic  re- 
medy can  huve  much  effect :  but  as  the  Peruvian  bark 

has 


O  F     P  H  Y  S  1C.  4o"i 

has  little  power  in  changing  the  (late  of  the  fluids,  fo 
it  can  have  little  effecl  in  fcurvy. 
MDCCCIX, 

I  fhall  conclude  rny  obiervations   upon   the  medi- 
cines employed  in  (curvy,   with  remarking,  that  the 
ufe  of  mercury  is  always  maniieftiy  hurtful. 
MDCGCX. 

After  having  obferved  that  both  the  prevention  and 
cure  of  this  difeafe  are  now  very  well  known,  it  may 
feem  unneceffary  to  enter  into  much  difcuiTion  con-  • 
cerning  its  proximate  caufe  :  but  as  fuch  difcuffions 
can  hardly  be  avoided,  and  as  falfe  opinions  may  iri 
fome  meafure  corrupt  the  practice,  I  fhall  venture  to 
fugged  here  what  appears  to  me  mod  probable  upon 
the  fubjecl:. 

MDCCCXT. 

Notwithstanding  what  has  been  afferted  by  fome 
eminent  perfons,  I  trufl  to  the  concurring  teltimony 
of  the  mod  part  of  the  authors  upon  the  fubjecl,  that 
in  fcurvy  the  fluids  fuffer  a  confiderable  change. 

From  thefe  authors  we  learn,  that  in  the  blood 
drawn  from  the  veins  of  perfons  labouring  under  the 
fcurvy,  the  crafHimentmn  is  different  both  in  colour 
and  confidence  from  what  it  is  in  healthy  perfons; 
and  that  at  the  fame  time  the  ferum  is  commonly 
changed  both  in  colour  and  tade.  The  excretions  al- 
fo,  in  fcorbutic  perfons,  ihow  a  change  in  the  date  of 
the  fluids.  The  breath  is  fetid  ;  the  urine  is  always 
high-coloured,  and  more  acrid  than  ufual;  and  if  that 
acrid  exfudation  from  the  feet,  which  Dr.  Hulme  tak-s 
notice  of,  happens  efpeciaily  in  fcorbutic  peifons,  ic 
will  be  a  remarkable  proof  to  the  iame-purpofe.  .Bu: 
however  this  may  be,  there  is  evidence  enough  that 
in  fcurvy  the  natural  date  of  the  fluids  is  considerably 
Changed.  Further,  I  apprehend  it  may  be  confidently 
prefurned  from  this,  that  the  difeafe  is  brought  on  by 
a  particular  noiirifUment  introduced  into  the  body,  and 

VOL.  II.  7  E 


402  PRACTICE 

is  as  certainly  cured  by  the  taking  in  of  a  different  di- 
et. In  the  latter  cafe,  the  diet  ufed  has  no  other  evi- 
dent operation,  than  that  of  giving  a  particular  ftate 
and  condition  to  the  fluids. 

MDCCCXII: 

Prefuming  therefore,  that  the  difeafe  depends  upcn 
a  particular  condition  of  the  fluids  of  the  body,  the 
next  fubjed  of  inquiry  is.  What  that  condition  may 
be? 

With  this  view  I  muft  obferve,  that  the  animal 
ceconomy  has  a  lingular  power  of  changing  acefcent 
aliments,  in  fuch  a  manner,  as  to  render  them  much 
more  difpofed  to  putrefaction;  and  although,  in  a 
living  ftate,  they  hardly  ever  proceed  to  an  actually 
putrid  Hate  ;  yet  in  man,  whole  aliment  is  of  a  mixed 
kind,  it  is  pretty  certain,  that  if  he  were  to  live  entire- 
ly upon  animal  food,  without  a  frequent  fiipply  of  ve- 
getable aliment,  his  fluids  would  advance  further  to- 
wards putrefaction  than  is  confident  with  health. 

This  advance  towards  putrefaction  feems  to  coniift  in 
the  production  and  evolution  of  a  faline  matter  which 
did  not  appear  in  the  vegetable  aliment,  and  could  not 
be  produced  or  evolved  in  it,  but  by  carrying  on  its 
fermentation  to  a  putrefactive  ftate.  That  this  faline 
ftate  is  conftantly  in  fome  meafure  produced  and  evolv- 
ed by  the  animal  procefs,  appears  from  this,  that  cer- 
tain .excretions  of  faline  matter  are  constantly  made 
from  the  human  body,  and  are  therefore  prefumed  ne- 
ceflary  to  its  health. 

From  all  this,  it  may  be  readily  underftood,  how 
the  continual  ufe  of  animal  food,  efpecially  when  al- 
ready in  a  putrefcent  ftate,  without  a  mixture  of  vege- 
table, may  have  the  effect  of  carrying  the  animal 
procefs  too  far,  and  particularly  of  producing  and 
evolving  a  larger  proportion  of  faline  matter.  That 
fuch  a  preternatural  quantity  of  faline  matter  does  ex- 
lit  in  the  blood  of  fcorbutic  perfons,  appears  from 

the 


O  E1     PHYSIC.  403 

the  (late  of  the  fluids  above-mentioned.  It  will  be  a 
confirmation  of  all  this  to  obferve,  that  every  interrup- 
tion of  perfpiration,  that  is,  the  retention  of  faline 
matter,  contributes  to  the  production  of  fcurvy  ;  and 
this  interruption  is  efpecially  owing  to  the  application 
of  cold,  or  to  whatever  elfe  weakens  the  force  of  the 
circulation,  fuch  as  the  neglect  or  want  of  excrcife, 
fatigue,  and  defpondency  of  the  mind.  It  deferves  in- 
deed to  be  remarked  here,  that  one  of  the  firft  effects 
of  the  fcurvy  once  induced,  is  very  foon  to  occafion  a 
great  debility  of  the  fyftem,  which  occafions  of  courfe 
a  more  rapid  progrefs  of  the  difeafe.  How  the  Hate  of 
the  fluids  may  induce  fuch  a  debility  is  not  well  un- 
derftood  ;  but  that  it  does  depend  upon  fuch  a  Hate 
of  the  fluids,  is  rendered  fufficienrly  prefumable  from 
what  has  been  faid  above  with  regard  to  both  the 
cauies  and  the  cure  of  fcurvy. 

MDCCCXIII. 

It  is  poflible  that  this  debility  may  have  a  great  (hare 
in  producing  feveral  of  the  phenomena  of  fcurvy  ;  but 
a  preternaturally  faline,  and  confequently  diflblved, 
ftate  of  the  blood,  will  account  for  them  with  more 
probability;  and  I  do  not  think  it  necefTary  to  perfons 
who  are  at  all  accuftomed  to  reafon  upon  the  animal 
ceconomy,  to  explain  this  matter  more  fully.  I  have 
only  to  add,  that  if  my  opinion  in .fuppofing  the  prox- 
imate caufe  of  fcurvy  to  be  a  preternaturally  faline 
ftate  of  the  blood,  be  at  all  founded,  it  will  be  fuffi- 
ciently  obvious,  that  the  throwing  into  the  body  along 
with  the  aliment  an  unufual  quantity  of  fait,  may  have 
a  great  mare  in  producing  the  difeafe.  Even  fuppof- 
iag  fuch  fait  to  fuffer  no  change  in  the  animal  body, 
the  effect  of  it  may  be  cpnfiderable  ;  and  this  will  be 
rendered  (till  more  probable,  if  it  may  be  prefumed, 
that  all  neutral  ialts,  coniifting  of  a  fixed  alkali,  are; 
changed  in  the  animal  body  into  an  ammoniacal  fait ; 
which  I  apprehend,  to  be  that  efpecially  prevailing  in 

3  E  2  fcurvy. 


404 


PRACTICE 


fcurvy.  If  I  be  at  all  right  in  concluding,  that  meats-, 
from  being  falted,  contribute  to  the  production  of  (cur- 
vy, it  will  readily  appear,  how  dangerous  it  may  be  to 
admit  the  conclufion  from  another  theory,  that  they 
are  perfectly  innocent. 

MDCCCXIV. 

Having  thus  endeavoured  to  explain  what  relates 
to  the  cure  of  fcurvy  in  general,  I  judge  it  proper  to 
leave  to  other  authors,  what  relates  to  the  manage- 
ment of  thofe  fymptoms  which  require  a  particular 
treatment. 


CHAP.     IV. 
O  !«'    J  iA  U  N  D  I  C  E. 

MDCCCXV. 

I  HAVE  here  palled  over  feveral  of  the  titles  in  my 
nofology,  becaufe  they  are  ^iftafes  not  of  this  iflanci. 
In  thefe,  therefore,  I  have  no  experience  ;  and  with- 
out that,  the  compiling  from  other  writers  is  always 
extremely  fallacious,  for  thefe reafons  I  omit  them  ; 
and  mail  now  only  offer  fome  remarks  upon  thefubjecl 
of  jaundice,  the  lafc  in  order  that  I  can  poilibly  intro- 
duce in  my  courfe  of  Lectures. 

MDCCCXVI. 

The  jaundice  confifts  in  a  yellow  colour  of  the  fkin 
over  the  whole  body,  and  particularly  of  the  adnataof 
the  eyes.  This  yellow  colour  may  occur  from  differ- 
ent caufes  :  but  in  the  jaundice,  hereafter  to  be  more 
exactly  chara&erifed,  I  judge  it  to  depend  upon  a 
quantity  of  bile  prefcnt  in  the  mafs  of  blood  ;  and 

which,' 


OF    PHYSIC.  4©5 

which,  thrown  out  upon  the  furface,  gives  its  own  pra_- 
per  colour  to  the  {kin  and  eyes. 

MDCCCXVII. 

That  the  difeafe  depends  upon  this  we  know  parti- 
cularly and  certainly  from  the  caufes  by  which  it  is 
produced.  In  order  to  explain  thefe,  I  muft  obferve, 
that  bile  does  not  exift  in  its  proper  form  in  the  mafs 
of  blood,  and  cannot  appear  in  this  form  till  it  has  pa.,1- 
ed  the  fecretory  organ  of  the  liver.  The  bile,  there- 
fore, cannot  appear  in  the  mafs  of  blood,  or  upon  the 
furface  of  the  body,  that  is,  produce  jaundice  from  any 
interruption  of  its  lecretion  ;  and  accordingly,  if  jaun- 
dice does  appear,  it  muft  be  in  confequence  of  the 
bile,  after  it  had  been  fcccrned,  being  again  taken  into 
the  blood-vcffels. 

This  may  happen  in  two  ways;  either  by  an  inter- 
ruption of  its  excretion,  that  is,  of  its  pafTage  into  the 
duodenum,  which  by  accumulating  it  in  the  biliary 
veflels,  may  giveoccafion  to  its  pairing  again  into  the 
blood-veifels ;  or  it  may  pafs  into  thefe,  by  its  being 
abforbed  from  the  alimentary  canal,  when  it  happens 
to  be  accumulated  therein  an  unufual  quantity.  How 
far  the  latter  caufe  can  take  place,  or  in  what  circurn- 
ilances  it  does  occur,  I  cannot  clearly  afcertain,  and  I 
apprehend  that  jaundice  is  feldom  produced  in  that 
manner. 

MDGCCXVIII. 

The  former  caufe  of  flopped  excretion^  may  be  un- 
deritood  more  clearly  ;  and  we  have  very  certain  proof 
of  its  being  the  ordinary,  and  indeed  the  almoft  univer- 
fal^  caufe  of  this  difeafe.  Upon  this  fubjecl  it  will  be 
obvious,  that  the  interrupted  excretion  of  the  bile 
mud  depend  upon  an  ob(tru<5tiori  of  the  duclus  com- 
munis  choledocbus ;  the  mod  common  caufe  of  which 
is  a  biliary  concretion  formed  in  the  gall-bladder,  and 
from  thence  fallen  down  into  the  duclus  cornmunis, 
it  being  at  the  fame  time  of  fuch  a  fize  as  not  to  pafs 

readily 


4o5  P  R  A  C  T  I  C  E 

readily  through  that  dud  into  the  duodenum. 
dud  may  like  wife  be  obflruded  by  a  fpafmodic  con- 
Itridion  affeding  it :  and  fuch  fpafm  may  happen,  ei- 
ther in  the  dud  itfeif,  which  we  fuppofe  to  be  contrac- 
tile ;  or  in  the  duodenum  preiiing  the  fides  of  the  dud; 
clofe  together ;  or,  laitly,  the  dud  may  be  ohftruded 
by  a  tumour  comprefling  it,  and  that  arifyig  either  in 
the  coats  of  the  dud  itfeif,  or  in  any  of  the  neighbour- 
ing parts  that  are,  or  may  come  to  be,  contiguous  to 

MDCCCX1X. 

When  fuch  obftrtidion  happens,  the  fecreted  bile 
mil  ft  be  accumulated  in  tine  biliary  duds ;  and  from 
thence  it  may  either  be  abforbed  and  carried  by  the 
lymphatics  into  the  blood-verTels,  or  it  may  regurgitate 
in  the  duds  themfeives,  and  pafs  from  them  directly 
into  the  afcending  cava.  In  either  way,  it  comes  to  be 
ciiiiuied  in  the  mafs  of  blood  ;  and  from  thence  may 
pafs  by  every  exhalant  verTel,  and  produce  the  difeafe 
in  queftion. 

MDCCCXX. 

I  have  thus  fhortly  explained  the  ordinary  prod  tic* 
tion  of  jaundice  :  but  it  mutt  be  obferved  further, 
that  it  is  at  all  times  accompanied  with  certain  other 
fymptoms,  fuch  as  a  whitencfs  of  the  faces  a]vin(p^ 
which  we  readily  account  for  from  the  abfence  of  bile 
in  the  inteftines ;  and  generally,  aif®,  with  a  certain 
confidence  of  the  faeces,  the  caufe  of  which  is  not  fo 
eafy  to  explain.  The  difeafe  is  always  accompanied 
alfo  with  urine  of  a  yellow  colour,  or  at  Jeaft  with  urine 
that  tinges  a  linen  cloth  with  a  yellow  colour.  Thcfe 
are  conftantly  attending  fymptoms;  and  though  not 
always,  yet  there  is  commonly,  a  pain  felt  in  the  epiga- 
ilriurn,  correfpcnding,  as  we  fuppofe,  to  the  feat  of  the 
dudus  comraunis.  This  pain  is  often  accompanied 
with  vomiting ;  and  even  when  the  pain  is  not  confi- 
derable,  a  vomiting  fometimes  occurs.  In  fome  cafes, 

when 


OF    PHYSIC.  467 

when  the  pain  is  confiderable,  the  pulfe  becomes  fre- 
quent, full,  and  hard,  and  fome  other  fymptoms  of  py- 
re xia  appear. 

MDCCCXXI. 

When  the  jaundice  is  occalioned  by  tumours  of  the 
neighbouring  parts  compreffing  the  biliary  duel:,  I  be- 
lieve the  difeafe  can  very  feldom  be  cured.  That  fuch 
is  the  caufe  of  jaundice,  may  with  fome  probability  be 
fuppofed,  when  it  has  come  on  in  confequenee  of  other 
difeafes  which  had  fublided  long  before,  and  more  espe- 
cially fuch  as  had  been  attended  with  fymptoms  of  ob- 
itrucled  vifcera.  Even  when  the  jaundice  has  fubfi fl- 
ed long  without  any  intermiflion,  and  without  any 
pain  in  the  epigaftrium,  an  external  compreilion  is  to 
be  fufpeded. 

MDCCCXXII. 

In  fuch  circumftancesj  I  confider  the  difeafe  as  in- 
curable ;  and  it  is  almofl  only  when  the  difeafe  is  oc- 
cafioned  by  biliary  concretions  obftru&ing  the  biliary 
duel,  that  we  may  commonly  expe£k  relief,  and  that 
our  art  may  contribute  to  the  obtaining  it.  Such 
cafes  may  be  generally  known  by  the  difeafe  frequent- 
ly difappea'ring  and  returning  again  ;  by  our  finding, 
after  the  former  accident,  biliary  concretions  ambngft 
the  fasces ;  and  by  the  difeafe  being  frequently  accom- 
panied with  pain  of  the  epigastrium,  and  with  vomit- 
ings ariiing  from  fuch  pain. 

MDCCCXXIIL 

In  thefe  cafes,  we  know  of  no  certain  and  immedi- 
ate means  of  expediting  th/j  paffage  of  ihe  biliary  con- 
cretions. This  is  generally  a  work  of  time  depending 
upon  the  gradual  dilatation  of  the  biliary  duel ;  and  it 
is  furpiiiing  to  obfcrve,  from  the  iize  of  the  (tones 
which  fometimes  pafs  through,  what  dilatation  the 
duel  will  admit  of.  It  proceeds,  however,  falter  or 
flower  upon  different  occafions ;  and  therefore  the 
jaundice,  after  a  various  duration,  often  ceafes  fudden- 


P  R  A  C  T  I  C  E 

ly  and  fpontaneoufly.  It  is  this  which  has  given  rife 
to  the  belief,  that  the  jaundice  has  been  cured  by 
fuch  a  number  and  fuch  a  variety  of  different  reme- 
dies. Many  of  theie,  however,  arc  perfectly  inert,  and 
many  others  of  them  fuch  as  cannot  be  fuppofed  to 
have  any  eifect  in  expediting  the.paflage  of  a  biliary 
concretion.  1  ihall  here,  therefore,  take  no  notice  of 
the  numerous  remedies  of  jaundice  mentioned  by  the 
writers  on  the  Materia  Medica,  or  even  of  thofe  to  be 
found  in  practical  authors  ;  but  fnall  confine  myfelf  to 
the  mention  of  thole  that  may  with  probability  be  fup- 
pofed to  favour  the  paflage  of  the  concretion,  or  re- 
move the  obftacles  to  it  which  may  occur. 
MDCCCXXIV. 

In  the  treatment  of  this  difeafe,  it  is  in  the  firft  place, 
to  be  attended  to,  that  as  the  diftenfion  of  the  biliaiy 
duel,  by  a  hard  mafs  that  does  not  eafily  pafs  through 
it,  may  excite  inflammation  there  ;  fo,  in  perfons  of 
tolerable  vigour,  blood-letting  may  be  an  ufeful  pre- 
caution ;  and  when  much  pain,  together  with  any 
degree  of  pyrexia,  occurs,  it  becomes  an  abfolutely 
necelfary  remedy.  In  fome  inftances  of  jaundice  ac- 
companied with  thefe  fymptoms,  I  have  found  the 
blood  drawn  covered  with  an  inflammatory  cruft  as 
thick  as  in  caies  of  pneumonia. 

MDCCCXXV. 

There  is  no  means  of  puihing  forward  a  biliary  con- 
cretion that  is  more  probable  than  the  action  of  vo- 
•miting  ;  which,  by  compreiling  the  whole  abdominal 
vifcera,  and  particularly  the  fall  and  diftended  gall- 
bladder and  biliary  veifels,  may  contribute,  fqmet'imes 
gently  enough,  to  the  dilatation  of  the  biliary  duel. 
Accordingly  vomiting  has  often  been  found  ufefui  for 
this  purpofe  ;  but  at  the  fame  time  it  is  poilible,  that 
the  torce  exerted  in  the  ad  of  vomiting  may  be  too 
violent,  and  therefore  gentle  vomits  ought  only  to  he 
employed.  And  either  when,  by  the  long  continu- 
ance 


OF    PHYSIC.  409 

ance  of  the  jaundice,  it  may  be  fufpe&ecl  that  the  iize 
of  the  concretion  then  palling  is  large  ;  or  more  efpe- 
cially  when  pain  attending  the  difeafe  gives  apprehen- 
fion  of  inflammation,  it  may  be  prudent  to  avoid  vo- 
miting altogether. 

MDCCCXXVI. 

It  has  been  ufual  in  the  jaundice  to  employ  purga- 
tives ;  and  it  is  poffible  that  the  aclion  of  the  intef- 
tines  may  excite  the  adlion  of  the  biliary  duels,  and 
thus  favour  the  expuliion  of  the  biliary  concretion  : 
but  this,  I  think,  cannot  be  of  much  effecl: ;  and  the 
attempting  it  by  the  frequent  ufe  of  purgatives,  may 
otherwife  hurt  the  patient.  For  this  reafon  I  appre- 
hend, that  purgatives  can  never  be  proper^  excepting 
when  there  is  a  flow  and  bound  belly*. 
MDCCCXXVII. 

As  the  relaxation  of  the  ikin  contributes  to  relax 
the  whole  fyitem,  and  particularly  to  relieve  the  con- 
ftri&ion  of  fubjacent  parts  ;  fo,  when  the  jaundice  is 
attended  with  pain,  fomentations  of  the  epigaftriurn 
may  be  of  fervjce. 

MDCCCXXVIII. 

As  the  folids  of  the  living  body  are  very  flexible  and 
yielding;  fo  it  is  probable,  that  biliary  concretions 
would  in  many  cafes  find  the  biliary  duel  readily  ad- 
mit of  fnch  dilatation  as  to  render  their  pafTage 
through  it  eafy,  were  it  not  that  the  diftenfion  occa- 
fions  a  preternatural  fpafmodic  contraction  of  the  parts 
below.  Upon  this  account,  opium  is  often  of  great 
benefit  in  jaundice ;  and  the  .benefit  refulting  from  its 

VOL.  II.  3  F  ufe, 

The  good  effe&s  of  purgatives,  in  removing  biliary  concre- 
tions in  the  du£,  are  fufficicntly  apparent  by  daily  experience.  It 
is  true,  indeed,  that  all  purgatives  have  not  this  effe&,  cfpecially 
fuch  as  are  of  a  gentle  and  flow  operation.  The  draflic  purges,  how- 
ever, whofe  a£tion  is  both  brifk,  and  of  long  continuance,  have  fre- 
quently been  attended  with  good  effefts.  Some  formula:  of  thefe 
bnik  draftics  have  been  defcribed  in  the  notes  on  article  168-?. 


4io  PRACTICE 

ufe,  proves  fufficiently  the   truth  of  the  theory  upon 
which  the  ufmg  of  it  has  been  f.  unded. 

MDCCCXX1X. 

It  were  much  to  be  wiflied,  that  a  folvent  of  biliary 
concretions,  which  might  be  applied  to  them  in  the 
gall-bladder  or  biliary  dudfo,  was  difcovered;  but  none 
fuch,  fo  far  as  I  know,  has  yet  been  found  ;  and  the 
employment  of  foap  in  this  difeafe,  I  confider  as  a 
frivolous  attempt.  Dr.  White  of  York  has  found  a 
folvent  of  biliary  concretions  when  thefe  are  out  of 
the  body  ;  but  there  is  not  the  leail  probability  that 
it  could  reach  them  while  lodged  within. 


INDEX. 


INDEX 


TO    THE    TWO    VOLUMES, 


N.  B.   Tfce  Figures  refer  to  the  number  of  Paragraphs, 


ABSCESS,  250 

ABSCESSES  and  ULCERS,  the  caufes  of  their  dif- 
ferent ftates  254 
ACIDS,  employed  in  fever  134 
refrigerant  in  fever  ib, 
ACTION  of  the  heart  and  arteries,  how  increafed  for  pre- 
venting the  recurrences  of  the  paroxyfms  of  in- 


termitting fever 
ADYNAM^E 
AMENORRHOEA, 

from  retention, 


when  occurring 
fymptoms  of 
caufes  of 
cure  of 


230 
1171 

9.95 
996 
998 

999 

1000 2 

1CO2 — 6 
A  ME- 


i    N    r> 


AMENORRHOEA  from  fnppreffion, 


when,  occurring 
fymptoms  of 
caufes  of 
cure  of 


10OO 

1010 
1008 — 9 

1011 — 12 

AMENTIA  ,598 

ANASARCA,  i668 

the  character  of  ib. 

phenomena  of  !668 — 73 

cure  of  X674 — 96 

diftinguifhed  frorn.  Leucophlegmatia  1669 

ST.  ANTHONY'S  FIRE.     See  Erythema. 

ANTIMONIAL  EMETICS,   employed  in  fevers  181 

their  different  kinds  ib. 

the  cidminiftration  of  them  in 

fevers  183 — 6 

ANTIPHLOGISTIC  REGIMEN,  129 

how  conducted  130 
when  employed  in  inter- 
mittent f eve  is  2,34 
ANTISPASMODICS  employed  in  fevers 
APHTHA 


APOPLEXY 


diftinguifhed  from  pslff 
diftinguifhed  from  fyncope 
predifponent  caufes  of 
exciting  caufes  of 
proximate  caufe  of 
SEROSA,  proximate  caufe  of 

prognoftic 

frequently  ending  in  hemiplegia 

prevention  of 


152 — 187 

733 
1094 

ib. 

ib. 

109,5 

1098 — 1115 — 16- 

1100 — 21 
1114 

1122 — 2J 
1  1  22 
1124 


whether  fanguine  or  ferous,  ftimulants 

hurtful  in  it 

from  powers  that  deftroy  the  mobility 

of  the  nervous  power 

cure  of 
APYREXIA 
ASCITES, 

character  of 
its  various  feat 
the  phenomena  of 


1136—37 


1138 


24 
1709 

ib. 

1710  —  ii 
1712—13 

ASCITSS, 


INDEX.  iS 

ASCITES,  its  particular  feat  difficultly  afcertained  1714 

the  cure  of  *7*5 — 17 

ASTHMA,  1373 

phenomena  of  1 375 

exciting  caufes  of  1381 

proximate  caufe  of  *3$4 

diftinguifhed  from  other  kinds  of  dyfpnoea        1385 
ASTHMA,  fometimes  occalions  the  phthifis  pulrnonalis  1386 
frequently  ends  in  hydrothoiax  ib* 

feldom  entirely  cured  ib. 

ASTRINGENTS,  employed  in  intermittent  fevers  231 

joined  with  aromatics,  employed  in  in- 
termittent fevers  ib, 
joined  with  bitters,  employed  in  inter- 
mittent fevers                                              ib. 
ATRABILIS                                                                         1029 
AT.ROPHIA,  ab  alvi  fluxu                                                       1607 
debilium                                                                1606 
inanitorum-                                                   .        1607 
infantilis                                                                   ^oj 
laclantium                                                               ib. 
lateralis                                                          1606 — it 
a  leucorrhoea,                                                          607 
nervofa,                                                                    606 
nutricum,                                                               607 
a  ptyalifma,                                                             ib. 
rachitica,                                                                  605 
fenilis,                                                            1606  — n 
AURA  EPILEPTICA,                                                             J3°6 

B. 

EITTEHS  employed  in  intermittent  fevers,  231 

joined  with  aftringents,  employed  in  intermittents,        i^. 
BLISTERINGJ  its  efFecis,  189 — 197 

its  mode  of  operation  in   the  cure  of 

fevers,  190 — 194 

when  to  be  employed  in  fevers,  195 

where  to  be  applied  in  fevers,  n^6 

BLOOD-LETTING,  the  employment  of  it  in  fevers,   138—143 

the  circumftances  directing  its  ufe  in  fevers,    142 

the  adminiftration  of  it  in  fevers,  143 

when  employed  in  intermittent  fevers,  234 

C. 

CACHEXIES,  character  of  the  clafs,  1,599 

CACHEXY, 


rr  INDEX. 

CACHEXY,  the  term,  how  applied  by  authors, 

CALCULUS  RENALIS,  429 

CALX  NITRATA  ANTIMONII,  its  ufe  in  fevers,         183—185 

CANINE  MADNESS,  3525 

the  cure  of,  1525 — 1527 

CARDIALGIA,  1427 

CARDITIS,  383 

of  the  chronic  kind,  ib. 

CARUS,  l°94 

CATAPHORA,  ib. 

CATARRH,  I04g 

predifpofition  to,  1047 

fymptoms  of,  ,048 

remote  caufes  of,  f©47 

proximate  caufe  of,  1057 

cure  of,  i°65 

produces  phthifis,  10^5 

paffes  into  pneumonia,  10,54 

produces  a  peripneumonia  notha,  1056 

CONTAGIOUS,  1062 

CATARRHUS  SUFFOCATIVUS,  376 

CHANCRE,  method  of  treating,  1781 

CHICKEN-POX,  631 

how  diftinguifhed  from  fmall-pox,          632 

CHINCOUGH,  1402 

contagious,  ibp 

frequently  accompained  with  fever,         1410 

phenomena,  1404 

prognoftic  in,  1413 

cure  of,  1414 

CHLOROSIS,  9^5 

CHOLERA,  1453 

fymptoms  of,  X4<53 — 5& 

remote  caufes  of,  *4£8 — So 

proximate  caufes  of,  14 54 

cure  of,  1462 — 64 

CHOREA,  1347 

phenomena,  1347 — 53 

cure  of,  1354 

CHRONIC  weaknefs,  1191 

COELIACA,  1493 

COLD, 


INDEX. 

COLD,  its  operations, 
abfolutc, 
•relative, 

its  general  effects  on  the   human  body, 

its  morbid  effects,  ^2 

moderates  the  viol«nce  of  reaction  in  fever,  133 

its  tonic  power,  how  to  be  employed  in  fevers,     20,5 

COLD  drink,  an  ufeful  tonic  in  fevers,  206 

the  limitation  of  its  ufe  in  fevers,  207 

air  applied  in  fevers,  208 

water  applied  to  the  furface  of  the  body  in  fevers,  205 — 209 

COLIC,  1435 

the  fymptoms  of,  1435 — 38 

proximate  caufe  of,  1439 

cure  of,  M41 

Devonfhire.      See  Colic  ofPoitou. 

COLIC,  of  Poitou,  1451 

cure  of,  *452 

COMA,  J093- 

CoMATA,  I093 

CONTAGIONS,  78 

their  fuppofcd  variety,  79 

CONVULSIONS,  1253 

CORPULENCY,  1621 

CYNANCHE,  300 

MALIGNA, 

PAROTIBEA, 

PHARYNGEA,  33 1 

TONSILLARIS,  301 

TRACHEALIS,  318 

as  affecting  infants,  322 — 329 

the  cure  of  it,  330 

CYSTITIS,  431 

D. 

DAYS  critical,  in  fevers,  107 — 124 

non-critical,  113 

DEATH,  the  caufes  of,  in  general,  .100 

the  direft  caufes  of,  ib. 

the  indirect  caufes  of,  ib. 

the  caufes  of  it  in  fever,  101 

DEBILITY,  infcvers,  the  fymptoms  of,  104 

DEBILITY, 


vi  INDEX. 

DEBILITY,  how  obviated,  203 

DELIRIUM,  in  general,  explained,  1<529 — 50 

in  fever,  of  two  kinds,  45 

or  INSANITY  without  fever,  1,550 — 57 

DIABETES,  1504 

fymptoms  of,  15°4 — 9 

remote  caufe  of,  I5°8 

proximate  caufe  of,  15 10 — 12 

cure  of,  1,513 

DI^ITA  AQUEA,  1,57 

DIARRHOEA,  1465 

DIARRHOEA,  diftinguifhed  from  dyfentery,  1466 

diftinguifhed  from  cholera,  1i"7 

proximate  caufe  of,  X4O^ 

remote  caufes  of,  M71 — 93 

cure  of,  2494"~"15ca 

BILIOSA,  1480 

COLLIQUATIVE,  I^Ol 

MUCOSA,  1488 

DIATHESIS  FHLOGXSTICA,  62 — 247 

how  removed,  260 

DILUENTS,  their  ufe  in  fevers,  154 — 158 

DISEASES,  the  diftinguifliing  of  them,  how  attained,  2 

the  prevention  of  them,  on  what  founded,  3 

the  cure  of  them,  on  what  founded,  4 

DROPSIES,  1645 

in  general,  the  caufe  of  them,  1646 
of  the  breaft.      See  Hydrothorax. 
of  the  lower  belly.     See  Af cites. 

DYSENTERY,  1067 
contagions,  JO75 
remote  caufes  of,  1272 
proximate  caufe  of,  I077 
cure  of,  1 08© 
ufe  of  mild  cathartics  to  be  frequently  repeat- 
ed in  it,  ib. 
rhubarb  improper  in  it,  ib» 
DYSENTERIA  ALBA,  1070 
DYSMENORHOEA,  1014 
DYSPEPSIA,  JI9°.' 
re  m  o  tc  ca  ufes  of,  1 1 9  $ 

DYSPEPSIA, 


INDEX,  vii 

DYSPEPSIA,  proximate  caufe  of  1193 

cure  of  1201 

flatulence  in  it,  cure  of  1221 

heart-burn  in  it,  cure  of  ib. 

pains  of  (lomach  in  it,  cure  of  ib. 

vomiting  in  it,  cure  of  ib. 

DYSPNOEA,  1365 

E. 

EFFLUVIA,  human  85 

from  marines  ib. 

EMACIATIONS,  1600 

caufes  of  1602 — 18 

cure  of  1619 

EMANSIO.  MENSIUM  998 

JLMETICS,  failed  to  the  cure  of  fevers  174 

their  effecls  176—180 

a  means  of  removing  fpafm  I/O 

the  adminiftration  of,  in  fevers  175 

their  ufe  in  intermittent  fevers.  5230 — 233 

EMPROSTHOTONOS,  1267 

ENTERITIS,  404 

phlegmonic  or  erythematiQ  ib, 

caufes  of  407 

rure  of  409 

EPILEPST,  128 

phenomena  of  1283 

pioximate  caufes  of  1284 
remote  caufes  of 
predifponent  caufes  of 
fympatnic, 

cure  of  1317 

idiopathic,  *3i6 

cure  of.  1310, 

EPISTAXES,  806 

the  caufes  of  it  808 

the  various  circumftances  of  807 — 818 

the  management  and  cure  of  819 — 8  2  9. 

ERYSIPELAS,  274 

of  the  face  708 

fymptoms  of  705 — 708, 

prpgnofis  of  706 

%  ERYSIPELAS,, 


via  INDEX. 

ERYSIPELAS,  proximate  caufe  of  69? 

cure  of  708 — 711 

phlegmonodes  in  different  parts  of  the  body    712 

attending  putrid  fever  7*3 

ERYTHEMA,  274 

EXANTHEMATA,  585 

EXERCISE,    ufeful  in  intermittent  fevers  23* 

F. 

r 

FAINTING     See  Syncope.  1171 

FATUITY,  1529 

FEAR,  a  remote  caufe  of  fever  97 

FEVER,  H 

ilri£lly  fo  called,  the  chara&er  of  8 — 32 

phenomena  of 

remote  caufes  of,  are  qfafec?ative  nature                   36 

proximate  caufe  of  33 
atony  of  the  extreme  veiTels,  a  principal  circum- 

ilance  in  the  proximate  caufe  of  it              43 — 44 
fpafm,  a  principal  part  in  the  proximate  caufe  of  it     46 

general  do&rine  of  46 

the  caufes  of  death  in  it  101 

the  prognofis  of  QQ 

indications  of  cure  in  126 

differences  of  53 

continent  28 

continued  27 

inflammatory  67 
miliary.     See  Millar y  Fever* 

nervous  67 

bilious  71 
fcarlet.      See  Scarlet  Fever. 

putrid  7  2 

pamed  fynocha  67 

fynochus  69 

typhus  '  67 

heaic,   *  74 

intermittent,    the  paroxyfms  of,  defcribed  10 

the  cold  flage  of  n 

FEVER. 


INDEX. 


FEVER,  intermittent,    the  hot  ftage  of 

the  fweating  ftage  of 

of  a  tertian  period 

of  a  quartan  period 

of  a  quotidian  period 

caufed  by  marfh  effluvia 

bile  not  the  caufe  of  it 

cure  of 

its  paroxjfms,  how  prevented 

attended  withphlogiftic  diathefis 

intermittent,  attended  with  congeftion 
in  the  abdominial  vifcera 

remittent  j 

FLUXES,  without  fever.      See  Profluvia. 
FLUOR  ALBUS.     See  Lcucorrlcta. 
FOMENTATION  of  the  lower  extremities,  its  ufein  fevers 
FOMITES  of  contagion 
FUNCTIONS  intellectual,  diforders  of  1,528—29 


It 

ib. 

25 

ib. 

ib. 

84 

51 

228 

229 

234 

234 
26 


199 
82 


G. 


GANGRENE  of  inflamed  parts,  the  caufe  of 
marks  of  the  tendency  to 
marks  of  its  having  come  on 
GASTRITIS, 

phlegmonic  or  erythematic 
phlegmonic,  the  feat  of 

the  fymptoms  of 
thecaufes  of 
the  cure  of 

erythematic,  how  difcovered 
the  feat  of 
the  cure  of 
GASTRODYNIA, 
GLEET, 
GONORRHOEA, 

phenomena  of 
cure  of 
GOUT,  the  character  of 

a  hereditary  difeafe 
diftinguiflied  from  rheumatifm 
b  2 


25<5~  256 

257 

ib. 

ib. 


-§5 


385 


1769 

1765 

65  —  69 

1770  —  78 

492 

500 

526 

GOUT, 


X  INDEX. 

GOUT,  predifponent  caufes  of  49*— r'63 

occaiional  caufes  of  5    '   -505 

proximate  caafe  of  5  -/ — ^33 

not  a  morbific  matter  /  29 

Regular,  delcribed  ,506 — ^18 

pathology  of  533 

cure  of  537—573 

no  efFe&ual  or  fnfe  remedy  yet  found 

for  the  cure  of  it  539 

•medicines  employed  for  it  556 

whether  it  can  be  radically  cured  540 
treatment  in  the  intervals  of  paroxyfms     542 

treatment  in  the  time  of  paroxyfms  560 

regimen  during  the  paroxyfms  561 

external  applications,  how  far  fafe  568 — 569 
blood-letting  in  the  intervals  of  paroxyfms    S53 

> — in  the  time  of  paroxyfms  ,563 

coftivenefs  hurtful  559 

laxatives  to  be  employed  ib. 

effeas  of  alkalines  553 

effects  of  Portland  powder  55  7 

irregular  <5i& 

Atonic,  574— 399 

pathology  of  534 

cure  of  580— 58* 

Retrocedent,  522 

pathology  of  535 

cure  of  580—582 

GOUT,  Mi/placed,  523 

pathology  of  536 

cure  of  583— <584 

Tranjlated,  two  particular  cafes  of  525, 

H. 

It  JEM  ATE  ME  S  1ST,  1O17 

arterial  and  venous  1027 
from  obilrufted  menflruation 
from  fuppreiTion  of  the  hemorrhoidal  flux 
from  compreilion  of  the  vafa  brevia  by  the 

fpleen 

from  obfhuaion  of  the  liver  1028 


INDEX. 


1033 

idiopathic,  improbable  *°33 — 34 

calculofa  IO3^ 

cure  of  ic>3& 

violenta  1O39 
from  fuppreffion  of  accuftomed  difcharges  1041 

putrida  1O43 

fpuria  et  lateritia  1044 

HUEMIPLEGIA,  1140 

caufes  of  1141 

frequently  occafioned  by  apoplexy  114^ 

frequently  alternates  with  apoplexy  J144 

cure  of  1152 

ftimulants,  of  ambiguous  ufe  in  1160 

flimulants,  external  in  116* 

HEMOPTYSIS, 

the  fymptoms  of  838 — 840 
the  caufes  of  760 — 763 — 830 — 836 
how  diflinguifhecl  from  ether  fpiitings  of 

blood  841 — 45 

cure  of  846 — 52 

H^EMORRHAGIA  UTERI,  966 

HEMORRJAGY, 

active  or  paflive  735 

character  of  736 

arterial  744 

venous  76^ 
the  caufes  of  the  different  fpecies  appearing  at 

different  periods  of  life  7,50 — 773 

the  general  phenomena  of  738 — 743 

the  remote  caufes  of  774 

cure  of  776 

whether  to  be  attempted  by  art  776 — 81 

prevention  of  the  firfl  attacks,  or  of  the 

recurrence  of  782 — 789 

treatment  of  when  prefent  789 — 805 

fymptomatic  IO15 

H/EMORRHOIDES     VESICLE  1042 

H&MORRHOIS, 

external  and  internal  925 

phenomena  of  925 — 931 

nature  of  the  tumours  932 

HJEMORRHOIS, 


zli  INDEX. 

HJEMORRHOIS,  caufes  of  933 — 

acquire  a  connection  with  the  fyttem  ^43 — 944- 

particularly  with  the  floraach  946 

cure  of  947 — 965 

HEPATIRRHOEA,  148; 

HEPATITIS,  412 

acute  and  chronic  ib. 

acute,  the  fymptoms  of  413 — 41^ 

combined  with  pneumonic  inflammation  416 

remote  caufes  of  it  ib. 

feat  of  418 

various  exit  of  pus  produced  in  421 

cure  of  422 

chronic,  the  feat  of  418 

how  difcovered  423 

HOOPING-COUGH.     See  Chincough.  1402 

HORROR,  impreflion  of,  employed  in  intermittent  fevers    23 1 

HUMAN  effluvia  the  caufe  of  fever  $i 

body,  its  temperature  88 

body  has  a  generating  h'eat  ib. 

HYDROPHOBIA,  1525 

HYDROTHORAX,  1697 

where  feated  *6g8 

fymptoms  of      f    -  1701 — 03 

often  combined  with  universal  dropfy       1704 

proximate  caufe  of  1706 

cure  of  17°7 — c8 

paracentefis  in  it,  when  proper  1708 

HYPERCATHARSIS,  1477 

HYPOCHONDRASIS,  1222 

phenomena  of  ib. 

diilinguiihed  from  dyfpepfia  1226 

proximate  caufe  of  1230 

cure  of  J232 

treatment  of  the  mind  in  1244 

HYSTERIA,  1514 

fymptoms  of  *5r5 — 1& 

paroxyfm  or  fit  defcribed  ib. 

rarely  appears  in  males  i^1/ 

how  diftinguiilied  from  hypochondriafis   1,518 — 19 

proximate  caufe  of  1522 

analogy  between  and  epilepfy  1,5*3 

HYSTERIA, 


J    N    D    E     X.  si 

HYSTERIA,   cure  of  2524 

Kbidinofa  *5?7 
HYSTERIC  difeafe.     See  EyJIeria. 

I. 

JAMES'S  powder,  its  ufe  in  fever  183 
JAUNDICE,                                                                    1815—16 
caufes  of                                                      1816—21 
cure  of                                                         1823 — 29 
ICTERUS.     ^t'Juujidice. 
ILIAC  paffion.     See  Ileus. 

ILEUS,  M37 

IM  FETIGINES,  J737 

character  of  the  order  ib. 
INDIGESTION.     See  Dyfpepfia* 

INFLAMMATION,  the  phenomena  of  235 

internal  the  marks  of  236 

the  flate  of  the  blood  in  237 

the  proximate  caufe  of  239 
not  depending  upon  alentor  of  the  blood  241 
fpafm.  the  proximate  caufe  of  243 — 248 

terminated  by  refolution  2/j^ 

by  fuppuration  250 

by  gangrene  PJ5 

jay  fcirrhus  258 

by  effufion  259 

l>y  blifters  260 

by  exfudations  261 

the  remote  caufes  of  262 

the  cure  of  in  general  264 

by  refolution  ib. 
when  tending  to  fuppuration              268 — 70 

when  tending  to  gangrene  271 

its  general  divilions  273 

more  ftri&ly  cutaneous  274 
of  the  bladder.  •  See  Cyjlitis. 
of  the  brain.      See  Phrenitis. 
of  the  heart.      See  Carditis. 
of  the  inteftines.     See  Enteritis. 
of  the  kidneys.      See  Nephritis. 
of  the  liver.      See  Hepatitis. 

INFLAMMATION, 


xiv  [INDEX, 

INFLAMMATION,  of  the  lungs.     See  Pneumonia 

of  the  pericardium.     See  Pericarditis, 
of  the  peritonaeum.     See  Peritonitis. 
of  the  fpleen.     See  Splenitis. 
of  the  flomach.     See  Go/Iritis. 

of  the  uterus  432 

INSANITY,  1535 
caufes  of                                                            *55°— 57 

of  different  fpecies  1557 

partial  and  general  difference  of  X575 
INTEMPERANCE  IN  DRINKING,  a  remote  caufe  of  fever      97 

INTERMISSION  OF  FEVER,  24 

INTERVAL  OF  FEVER,  124 

JNTUMESCENTIJE,  1620 

character  o£  the  order  ib. 

K. 

KING'S  EVIL.     See  Scroplula 

L. 

LEUCOFHLEGMATIA.  1669 

LEUCORRHOEA,  985 

character  of  986 
appearance  of  the  matter  discharged  in  987 — 992 

the  caufes  of  9^ 

the  effeas  of  99° 

the  cure  of  993 

LETHARGUS,  1094 

LIENTERY, 

LOOSENESS.     See  Diarrhcex. 

M, 

MADNESS.     See  Mania^ 

CANINE.     See  Canine. 
MANIA, 

the  fymptoms  of 

the  remote  caufes  of          , 

the  treatment  of  I562 — 74 

MANIAC 


INDEX.  xv 


MANIA,  occurring  in  fanguine  temperaments 

in  fanguine  temperaments,  cure  of  1577 

MARCORES,  1600 

MARSH  EFFLUVIA,  a  caufe  of  fever  84 

MEASLES,  633 

the  fjmptoms  of  637  —  642 

the  nature  of  644 

cure  of  645  —  650 

of  a  putrid  kind  634 

MEDICINE,  the  inftitution  of  4 

MELJENA,  1017 

MELANCHOLIA,  1^75 

how  diflinguimed  from  hypochon- 

driafis,  1,387—  88 

the  character  of  1,582  —  89 

the  proximate  caufe  of  I59° 

the  treatment  of  1592  —  97 

MELANCHOLIC  TEMPERAMENT,  I23° 

MELANCHOLY.     See  Melancholia. 

MENORRHAGIA,  966 

aclive  or  paffive  ib. 

when  a  difeafe  968  —  75 

effe&s  of  972 

proximate  caufe  of  977 

remote  caufes  of  97$ 

cure  of  980 

MENSES,  immoderate  flow  of  them.     See  Menorrbagia. 

METALLIC  TONICS,  employed  in  intermittent  fevers        231 

SALTS,  refrigerant  136 

METEORISMUS,  1633 

MIASMATA,  78 

MILIARY  FEVER, 

the  general  hiltory  of  714  —  715 

MILIARY  FEVER,  of  two  kinds,  red  and  white  716 

»                         white,  the  fjmptoms  of  717  —  719 

the  cure  of  720 

MORE  us  COELIACUS,          «  1493 

MUCOSUS,  .1070 

NIGER,  *O2e 

N. 

NEPHRITIS,  426 

the  fymptoms  of  ib. 

NEPHRITIS, 


*vi  I     N     D     E     X. 

NEPHRITIS, 

the  remote  caufes  of  427 

the  cure  of  430 
NERVOUS  DISEASES.     See  Neurofes. 

NEUROSES,  1090 

NEUTRAL  SALTS,   diaphoretic  in  fevers  i^p — 161 

refrigerant  in  feverfr  135 
NOSOLOGY,  Methodical 

O. 

OBESITY,  when  a  difeafe  1621 

ONEIRODYNIA,  1^98 

OPHTHALMIA,  278 

membranarum  ib. 

its  different  degrees  279—280 

its  remote  caufes  ib. 

the  cure  of  288 — 290 

tarfr  278 

the  cure  of  288 — 290 

OPIATES,  employed  in  the  hot  ftage  of  intermittent  fevers  233 

in  the  interval  of  intermittent  fevers  23 1 
OPISTHOTONOS.      See  'Tetanus. 

P. 

PALPITATION  of*the  heart  1355 

the  phenomena  of  ib. 

the  caufes  of  *356 

the  cure  of  J3^3 

PALSY,  1140 

diftinguifhed  from  apoplexj  Io94 

caufes  of  1141 

PARACENTESIS  in  afcites,  when  to  be  attempted  1717 

in  hydrothorax,  when  proper  1708 

PARAPHRENITIS,  343 

PAROXYSM  of  intermittent  fever,  the  recurrence,  how  to  ^ 

be  prevented  732 

PEMPHIGUS,  229 

PERICARDITIS,  383 

PERIPNEUMONIA  NoTHA,  376 

fymptoms  of  379 

pathology  of  3'^° 

the  cure  of  381 — 382 

fome  of  the  fymptoms  explained  350 

PERIFNEUMONY,  242 

PERITONITIS, 


N       D 


PERITONITIS, 

PERUVIAN  BARK,  not  a  fpecific 
its  tonic  power 
when  proper  in  fever 
how  moft  effectually  employed 
the  adminiftration  of,  in  intermittent  fevers 
the  tonic  chiefly  employed  in  intermittent  fevers 

PETECHIA, 


384 
213 

214 

215 

216 

23* 

ib. 
734 


PHLEGMON, 

PHRENITIS, 

the  character  of 
the  remote  caufes  of 
the  cure  of 

PHRENSY.     See  Pbrenitis. 
PHYSIC,  the  practice  of,  how  taught 

the  theory  of,  how   to  be  employed 
PHYSCONIA, 

PHTHISIS  PULMONALIS,  the  general  character  of 
always  with  an  ulceration  of  the  lungs 
the  pus  coughed  up,  how  diftinguimed 

from  mucus 

accompanied  with  he&ic  fever 
the  various  caufes  of  it 
from  hsemoptyfis 
from  pneumonia 
from  catarrh, 
from  aft h ma 
from  tubercles 

from  calcareous  matter  in  the  lungs 
if  contagious 

from  tubercles,  fymptoms  of 
its  different  duration 
the  prognofis  in 
the  cure  of 

the  treatment  of  when  ariling  from  tu- 
bercles 

the  palliation  of  fymptoms 
PLAGUE, 

the  general  character  of 
phenomena  of 
principal  fymptoms  of 

c   2 


274 
291 

293 
294 

295—299 


171 
8^53 


856 
857 
862 

864  —  865 

866  —  869 

870  —  873 

875 

876  —  882 
884 


889 

896 

$97 

899  —  924' 

906  —  921 
922  —  924 

665 

ib. 

667 

PLAGUE, 


xvii  INDEX. 

PLAGUE,  proximate  caufe  of  668 

prevention  of  670 — 68^ 

cure  of  686 — 695 

PLEURISY,  341 

PLEUROSTHOTONOS.     See  tetanus. 

PNEUMONIA,  or  PNEUMONIC  INFLAMMATION,  334 

general  fymptoms  of  335 — 339 

feat  of  340 — 344 

prognofis  of  352 — 360 

cure  of  361 
the  management  of  blood-letting  in  the 

cure  of  362 — 367 
the  ufe  of  purgatives  in  370 
the  ufe  of  emetics  in  371 
the  nfe  of  blifters  in  372 
the  means  of  promoting  expectoration  in        373 
the  ufe  of  fweating  in  374 
the  ufe  of  opiates  in  375 
POLYS  ARCA,  when  a  difeafe  1621 
cure  of  1^23 — 25 
PROFLUVIA,  1045 
character  of  the  clafs  ib. 
PULSE,  the  flate  of  the,  during  the  paroxyfm  of  an  in- 
termittent fever  12 
PURGING,  its  ufe  in  continued  fevers  **44 
intermit  tent  fevers  234 
Pus,  how  produced  250 
PUTRESCENCY  of  the  fluids  in  fever,  the  fymptoms  of      105 
the  tendency  to  in  fever,  how  to  be 
corrected  222 — 226 
PYLORUS,  SCIRRHOUS.     See  Dyfpepjia. 
PYREXIJE,  6 
character  of  the  clafs  7, 
orders  of  the  clafs  ib. 
PYROSIS,  M27 
fymptoms  cf  I431 
proximate  caufe  of  *433 
remote  caufes  of  M32 
cure  of  143^ 
Succica  of  Sauvages  142^ 

Q^ 

QuiNCY.       See  Cynanche. 

RACHITIS, 


INDEX. 

& 

RACHITIS,  1719 

its  origin  1720 

remote  caufes  of  1721 — 23 

phenomena  of  J724 

proximate  caufe  of  1725 — 28 

cure  of  J729 — 36 

REACTION  of  the  fyftem  59 

violent  in  fever,  fymptoms  of  103 

violence  of,  how  moderated  527 

REFRIGERANTS,  the  ufe  of  them  in  fever  134, 

REMEDIES,  table  of  thofe  employed  in  continued  fevers    227 

REMISSION  of  fever  25 

RESOLUTION  of  inflammation,  how  produced  249 

RESPIRATION,  the  changes  of,  during  the  paroxyfm 

of  an  intermittent  13 

REVOLUTION,   diurnal,  in  the  human  body  5^ 

RHEUMATISM,  acute  or  chronic  4^3 

Acute,  the  remote  caufes  of  405" 

the  proximate  caufe  of  44^ 460 

the  fymptoms  of  439 — 447 

cure  of  461 — 470 

Chronic,  fymptoms  of  450 

how  diftinguiflied  from  the  acute  4^1 

proximate  caufe  of  4^2 

cure  of  473 — 47^ 

how  diftinguiflied  from  gout  526 
PviCKETS.      See  Rachitis. 
ROSE,      See  Erythema. 
RUBEFACIENTS,  the  effecls  of  them. 

S. 

SCARLET  FEVER,  651 

the  fymptoms  of  636 

different  from  cynanche  maligna  651 — 6,55 

the  cure  of  6^7 — 664 

Sc  ROPHULA, 

the  phenomena  of  J73^- 
the  proximate  caufe  of 

not  contagious  1751 

not  arifing  from  the  lues  venerea  I7132, 

the  cure  of  1753 — 59 

Mefent  erica  1606 

SCUKVY, 


xix  INDEX. 

SCURVY,  1789 

remote  caufe  of  1792 — 1802 

cure  of  1 804 — 09 

proximate  caufe  of  1811 — 14 

SINAPISMS,  the  effects  of  them  197 

SKIN,  affections  of.      Sztlmpeiigijtes* 

SMALL-POX,  general  character  of  587 

fymptoms  of  the  diflindt  kind  589 

of  the  confluent  kind  ^90 — 593 
general  differences  between  diftinct  and 

confluent  594 

caufes  of  thefe  differences  595 — 600 

prognolis  in  593 

cure  of  601 — 630 

inoculation  off  602 
the  feveral  practices  of  which  it 

•  confifts  603 
the  importance  of  the  feveral 

practices  belonging  to  694 — 61 

management  of  fmall-pox  received  by  in- 

feaion  616—630 

SODA,  1427 

SPASM,  internal,  means  of  recovering  in  fevers  152 — 187 

the  proximate  caufe  of  inflammation  L243 — 24^ 

SPASMODIC  affection  without  fever  1251 

of  the  animal  functions  I426 

of  the  vital  functions  1355 

of  the  natural  functions  14  27 

SPACELUS,  255 

SPLENITIS,  425 

STIMULANTS,  when  to  be  employed  in  fevers  217 

their  ufe  in  intermittent  fevers  £30 

STOMACH,  its  confent  with  the  veffels  on  the  furface  of 

the  body  44 

SuDORincSj  arguments  for  their  ufe  in  fevers  163 — 167 

againfl  their  ufe  in  fevers  164 

SUPPURATION  of  inflamed  parts,  the  caufes  of  251 

the  marks  of  a  tendency  to  ib. 

formed,  the  the  marks  of  ib. 

SURFACE  of  the  body,    its  confent  with  the  flomach  44 

SWELLINGS,   general.     See  Intumef centime. 

adipofe  1621 

SWELLINGS, 


INDEX,  xx 

SWELLINGS,  flatulent  1626 

watery.     See  Dropjies. 

SWEATING,  wheu  hurtful  in  continued  fevers  165 

rules  for  the  conduct  of  in  continued  fevers      168 

life  of  in  intermittent  fevers  230 

SYNCOPE,  1171 

phenomena  of  ib. 

remote  caufes  of  JI74 — 1178 

predifpofuion  to  1184 

cure  of  1189 

diftinguifhed  from  apoplexy  1094 

SYNOCHA.     See  Fever. 

SYN o c HITS .     See  Fever. 

SIPHYLIS,  1760 

originally  from  America  1761 

how  propagated  1762 

and  gonorrhoosa,  how  dirlinguimed  1764 

the  cure  of  1783—88 

T. 

TABES  a  hydrope  1609 

a  fanguifluxu  1608 

dorfalis  1610 

glan  dularis  1 606 

mefenterica  ib. 

nutricum  1608 

rachialgia  1606 

fcrophulofa  ib- 

TARTAR  EMETIC,  itsufe  in  fevers  183 

TETANUS,  1257 

remote  caufes  of  1268 

cure  of  1270 

piflileum  Barbadenfe,  or  Barbadoes  tar,  in    1280 

LATERALIS,  1268 

TONIC  medicines  employed  in  continued  fevers  211 

intermittent  fevers  231 

TOOTHACH,  how  far  different  from  rheumatifm      4^7 — ^go 

fymptoms  of  47$ 

predifpofition  to  481 

remote  caufes  of  481 — 482 

proximate  caufe  of  483 

cure  of  485—491 

TRISMUS, 


xxi                                   I     N    D     E  X. 

TRISMUS.     See  Tetanus. 

NASCENTIUM,  128  f 

Tussis.     See  Catarrh. 

TYMPANITES,  the  charader  of  ^27 

the  different  fpecies  of  1628  —  30 

inteftinalis  1628 

enterophyfodes  ib. 

abdominal  is  ib. 

afciticus  ib. 

phenomena  of  1632 

proximate  caufe  of  1^35  —  36 

cure  of  1(^37  —  44 

TYPHUS.      See  Fever. 

the  fpecies  of  70 
V. 

VAPOURS,  or  low  fpirits.     See  Hypochrondriajis. 

VENE  RE  A  L  D  i  SE  A  SE  .     See  Sipbylis. 

VENERY,  excefs  in,  a  remote  caufe  of  fever  0,7 


in  general  1528 

VlS   MEDICATRIX  NATURE,  38 

ST.  VITUS'S  DANCE.     See  Chorea. 
VOMITING  OF  BLOOD.     See  H&matemejis. 

effefis  of  in  continued  fever  172  —  173 

the  ufe  of  intermitting  fevers  230  —  34 

U. 

URINE,  bloody.      See  H&maturia. 
URTICARIA,  the  hiflory  and  treatment  of  730 

W. 

WATEK-BRASH.      See  Pyrojls. 
WHITES.     See  Leucorrhcea. 

WARM-BATHING,  the  eile£is  of  in  fever  198 

the  admiriiftration  of  in  fever  199 

the  marks  of  the  good  effecls  200 

WINE,  the  moil  proper  ftimulant  in  fevers  218 

its  convenient   ufe   in  fevers  219 

when  hurtful  or  ufeful  in  fevers  220 


THE    E  N  D. 


(>* 


